HomeMy WebLinkAbout1489 D~claratlon ot Domlail~ and Citis~nship
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TO THE STATE AND COUNTY TAX ASSESSOR.
51. lUC1E ~OUNTY, FIORIDA: 2(ju~44
This i: my decla~ation of Oomicile and Citizenship in th~ State of Florid~ that I am filinq this day in ecoordance and
~n conformity with Chapter 22Z, Sectio~ 222.17, Florida Statutes.
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I was forme~ly a laga! ~esident of ~ -
(City) a»)
and I ~esided at ~~d_ / . However 1 have chan~ad my domirjle
(Street and Number)
to and am and have been a bo~a fide resident of the State of Florida sinoe day of
- , 1q~Q~ , and I roside at ~
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(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actua! legal residence and domicile in the State of Horidi.
(Insert here any pertinent facts, such as sale of property or busineu, or ~elinquishmant of employment
at fornier domicile, removal of family to new domicile, pu~chase of home, etc.)
~sL~ l~GG c.~E~~l~ ~s~
Fi~o ~NO RECO o
tT.lUC1E CO ~
IIOCER POI~RA=
Cl,ERt CIRCWT COII~j~,.K
QEC8R0 YERIfiE9~~~'
,I~ !5 I I o2 AM'T 1
203344
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~ I FURTHER CERTIFY that 1 wil) aompiy with all other requiremsnis of a lepal resident of this State.
i FURTHER CERTIFY that I have no intention to retum to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. .
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(Name)
~r~~Yelf~C f~~i~i~i/~
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~ ~,,:s~~e4l~~wb:utbed before me this ~`f f day of ~ , 19~~
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~ - b~;• f , Ot~T Natary Public
~ By"'N~ • j' Y ~ ~ O.C. My Commi:sion expiras
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(ti in dupliub and ori~inal Al~d whl~ CM~Ic prwh Couef, aed dupUWN wiN~ T~x A~~e?.)
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