HomeMy WebLinkAbout1638 D~cla~atlon ot OomMil• and Citit~nship
TO THE STATE AND COUNTY TAX ASSESSOR. 2p 3449
51. lUC1E COUNTY, FIORIDA:
This i: my decleration of Domicile and Citisenship in tht St~t~ of Norids that 1 am filinq this day in eaoordano~ a~d
in oonformity with Chapter 222, Section 224.17, Florid~ Ststutes.
I wss formerly a le9al resident of ^ _ ~ N I7~A K A
(Gity) . (Sta»)
and 1 resided at ~`s ~N/~S IC Howevsr 1 have chan~ed my domi~ile
(Stroet and Number) .
ro and am and have been a bona fide resident of the State of Florids sinoe ~ I•a-~ day of
U U S T , 19? and I roside at / S a 5 ~A Y S l~f 4i12 C ~DRJ v~
(Sheet snd Numbsr)
FORT MERCE, SAlNT lUC1E COUNTY, RORIDA
and this stateme~t is b be take~ as my declaration of citizenship, actval legal residence and domicile in the State of Florida.
(Insert here any pe~tinent facts, such a: sale of property ar business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchsse of home, etc.) .
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fIlEO ANO RECp~ E
ST.tt1C1EC0uNfY~~. -
ROCEti POITRA:
CLERK C~RCUIT COU~T -
- RECORO YERIFIEO~~.~'~°~
_•~u~ f 6 11 ~s ~M'~I ~
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I RJRTHER CERTIFY that I will comply with all ather requir~msnts of a(e~a) resident of this State.
1 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, perma~ently.
~az.,c.c~ .-~J. 7nc~~
~ (Name)
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(Address)
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,~rn:~ ~d wbscribed before me this v day of ~t 19L/
.
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~ ' , Notary Public
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~ . . . w D.C. My Commission expires
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~ ~_~d in duplkal~ and eri~inal A{~d wi~h C1~Ic qrarit Courf, and duplkat~ wilh Tax A~sser.)
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