HomeMy WebLinkAbout1397 i
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O~aluatlo~ ot Domlall~ ~u~d CltisMShip ~
TO TNE STATE AND COUNTY TAX ASSESSOR.
Sl. lUC1E CC~UNTY, FlOR10A:
This is my declaration of Domicile and Citis~nthip in th~ St~t~ of Fto?ida that 1~m filinq thii day in aooooda~a and
~n oonformity with Chapter 42Z, Ssttio~ 244.17, Florida Statutts.
I was formerly a leqal ~esident of ~
Kity) (Stat~)
and I resided at ~d.i~~.+~~~` HowevK 1 haw tharp~d my domiCile
~ (Stroef and Number) - `
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to and am a~d hsve been a bons fide resident of the St~t~ of Florida sinoe - day of
- ~ . 19~, and 1 roside at ~~f.1.~. ~7 ~ '
(Stroet ~nd.Numbst)
FORT rI~CE, SAINT LUCIE COUNTY, RORIOA
and this statement is to be taken as my detlaration of citizenship, actual lega) ~esidenoe and domicile in the Stste of Horida.
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(Insen hefe any pertinent facts, such as sale of propecty or business, or ~elinquishme~t of employme~t
st former domicile, removal of family to new domicile, purchsse of iame, efc.)
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~t~p AND ttECOR~~
ST.lUC1E COWITY ~
ItOCEit POtTRAi
IIECORO ERRfC1E0 C~Rt
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g I FURTHER CERTIFY that I will aomply with all oMtier reguir~fs of a Ipal rosident of this Shte.
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~ 1 FURTHER CERTIFY that I have no intention to retum to my former domi~ile, and I inter~d to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently. i9L ~/yd/YS~ ~C ,~/.~iQ
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~ ~ (Name)
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~ Sworn to and subscribed before me this ~3 day of 19~.
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~~l~tO1jRT Notary Public
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By •r D.C. My Commission expins
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~~li~.~..~d ..isin.~ fi{.a wiil~ a.~lc cirwM c.ere+, ,~a i~liat~ wiil~ T.ac A......ra
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tio. 13
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