HomeMy WebLinkAbout1452 ~Claratio~ ot Do~nicil• a~d Citis~~ahip
TO THE STATE ANO COUNTY TAX ASSESSOR,
203314
Sl. IUCIE COUNTY, FlOR1~A:
This is my decla~ation of Domicile and Citizenship in tht State of Florida that I am filin9 this d~y in sooo~danoe and
~n conformity with Chapte? 222, Section 222.17, Florida Statutes.
,
1 was fo~merly a legal resident of ~ ~n-~da'~~ ~
~ (City) aM)
and I ~esided at _~~.~Q~~l~~~ ~l~-C However 1 have chanqed my domitile
(Strset and Numbe~)
to and am and have been a bona fide resident of the State of Florida since -!_L~L,- day of
- . 19~~: a?td I reside at ~~"'~cz- ~~KC t_e.~
(Street a~d Numbe?)
FORT NERCE, SAINT LUClE COUNTY, FLORIDA
and this statement is to be taken as my daclaration of citizenship, actual legal residence and domicile in the State of Horida.
(Insert he~e any pertinent fads, such as sale of property or business, or relinquishme~t of employment
at forme~ domicile, removal of family to new domicile, purchase of home, etc.)
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~ ~G ~ ~ E lE0 AN[' RECOR E
U S~.111C1E COt1NTYSl~ `
~ CIERR C
~CU1T COURT
ItECORO YEit~F1E0
~ ~2 3~ P~I'11
2a3314
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1 FURTHER CERTIFY fhat I will oomply with al) other requiremenri of a leya) residsnt of this State.
1 FURTHER CERTIFY that I have no intention to retum to my former domiGle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ,
. .~~1.~-~.~~ ~a-~
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(Name) ~ ;
~ i~+ al
~ /V A s -7-o r.~
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~ (Address)
~ ~
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~ _ Swqr~,tp:~an~
,,,~6db~ibed before me this day of < , 19~
~ , ~
~ b~s:~_
~ • , •
~ , ~K C _~lRT Notary Public
~ By D.C. My Gommission expires
=i:i:. -
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~ (Te b~ ~x~cuhd in duplicah and ~i~lw~l AI~~ wili~ Cl~it CVwif Cou~f, and duplicah whh Tax Atwaor.)
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~ ° ~ i~ ~ i448
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