HomeMy WebLinkAbout1581 u~claratio~ of oomiail• anel Citlt~nshlp 2U3~ 11
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, fIORIDA:
This is my declaration of Domicile and Citisenihip in th~ St~t~ of Florid~ that 1~n+ filinq this day in aoo~rd~no~ and
~n confo?mity with Chapte~ 222, Sectio~ 222.17. Florid~ Statut~i. .
I was fo~me~ly a lagal ~esident of ~ 4~ ~~y`' -Cv- _
(City) ' (Sia 2r~
and I resided et ~C v-_ Flcwever 1 hav~ charpsd my domiCile
(Sh~et and Number)
ro and am and hsve been a bona fide resider~t of ths Stah of Florlda since - r~'~` day of
- - _ _ , 19 and 1 reside at ~ ~ ~ N• Lt/ ~ •
. (Street and Numb~r)
FORT r1ERCE, SAINT LUCIE COUNTY, RORIDA
and this stateme~t is to be taken as my declaration of citizenship, act~al legal residence and domicile in the State of Horida.
(Insert here any pertinent facts, such as sale of properry or busineu, or relinquishment of employmsr~t
at fo?mer domicile, removal of family b new domicile, purthase of horr~e, ett.)
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iT. `~CiE couMt°Y ~u°. •
ROCER POtTqAS
CIERiI CINCUIT C01tRt ~
11ECORD YE~i1f1E0..~~~
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r I FURTHER CEftTIFY that I will comply with ell othe~ requirementt of a le~al resident of thit Stab.
I FURTHER CERTIFY thai I have no intention b retum to my former domiCile, and 1 intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ ~ (Name)
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~ Sworn to and subscribed before me this day of , 19~.
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~ 8Y ' ~ D.C. My Commission ~xpires
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