HomeMy WebLinkAbout2199 O~la~ation of Do~nlail~ a~d Citis~nshlp
TO THE STATE ANO COUNTY TAX ASSESSOR, 2i1~~~~
Sl. ll1CiE COUNTY, FIORIDA:
This is my declar~tion of Domicile aRd Citiz~nship in th~ St~t~ of Florida th~t 1~m filinq thi: day in aaoo~d~nw ~nd
in confwmity with Chapte~ 22~, Ssction 24~.17, Florids Statutts.
I was formerly a teyal resident of _ _ C~1~d! _
(Cily) (Sts»)
end 1 ~esided st D~s 171_ RN~t~ However 1 haw chs~~ed my domiCi~e
(Straet and Numbe~)
to and am and have been a bona fide resident of the State of Flo?ids since ~_~r ~ day of
-r-----~- . 19~ , and I reside at lill Poaa~ d~ Loa
(Street and Number)
FORT PIHtCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal re:idenoe and domicile in the Stab of Horida.
(Insert here any pertinent facts, such as sale of propert~r or business, or ~elinquishment of employment .
at former domicite, removal of family to ~ew domicile, purchase .of home, etc.)~
I a~ a Caa~dian eitis~n (a r~~idut sli~a ~il-0TT-1~6)
tppl~~ ~o! L~~i~ l~~~~ FILEO ANO RECORDEO
iL WCIE COWITY FLA.
- ROCER POITIGS ~
CLERK CIRCUIT ,
~R~ `~s
RECORO VERIFIED ~~i`,..~.
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1 FURTNER ~ERTIFY that I will oomply with al) othe~ raquirements of s(e~sl residsnt of this Stete.
I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remein in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
C.t ,
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~ (Name) Jwa • D~o~ld
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~ '~~'~'ir.o~'to
~'gubwibed before me this ~ day of , 19 ~ .
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~ ~11 _ CONRT Notary Publk
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~ By ~ ' D.G. My Commission ~xpires
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