HomeMy WebLinkAbout1622 2o~3s
~ala~atio~ ot Domfaiis a~! CitisMShip
TO THE STATE AND COUNTY TAX ASSESSOR~
Sl. lUC1E COUNTY, FIORIDA:
This is my decla~~tion of Domicil• and Citis~nship in th~ Stat~ of Florid~ that 1 am filinq this day in aaoorda~ ~nd
~n conformity with Chepter 222. Section 2?~.17, Florid~ Shtutts.
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1 was formerly a ~eqs~ res~dent of ~~G'~--~ ~~1
(~ity) (Sht~) .
and 1 resided at ~~t Novwvaf I hav~ chan9sd my domitil~
(Stro~t s~d Num )
to and am and have been a bona fide resident of tl?~ State of Fiorida sinoe - day of
. 19 and 1 reside d ~~l Qit.lJe S~ . ~~ZT ~~l.Q'tc~~.
tro~t and Number)
I~RT ~CE, SAINT LUCIE COUNTY, FIOR~A -
and this statemant is to be taken as my decla~etion of citizenship, actual le~al residanos and domitile in ths State of Fbtida.
pnsert here any pertinent facts, such as sale of property or bu:i~ess, or relinquishment of employment
at former domicile, removal of family ro naw domicile, purchase af home, etc.)
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I fURTHER CERTIFY that I will oompty witfi all other requir~nb of a le~al rtsidMt of this Stab.
t RJRTNER CERTIFY that I have no intention to return to my fo?mer domicjle, and 1 intend to remsin in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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``~~~~t~?~r?ll/l (NAf11e)
; ~~i,:1 n~:;, ~ ~{osalie McBride
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r Ib ar~¢~ bsfors me this 8 dsy of , 19~.
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~ ROOER ~OITRAi
CIERK C~T COIIRT Notary Publk
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Sy D.C. My Commission expi~~s
(Te Ir~ ~x~aM~ iA drplical~ and e~al Al~d w~b GMIc Ci?ai1 CwN, and du~UwN wNh Tax A~~J
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