HomeMy WebLinkAbout2301 y
O~alaration of Oomlail~ •a~d Cltis~~shlp
TO THE STATE AND COUN~Y TAX ASSESSOR, x~~~.3i
Sl. tlK1E ~OUNTY. FtOR10A:
This it my d~cl~r~tion of Oomicil• a~d Citiz~nship i~ th~ Stat~ of Florid~ th~t 1 am fjlinq thii day in ~oootd~no~ and
in oonformity with Chspte? 222, S~ttion 222.17, Florida SbtutK.
I was formerly a Ipal resid~r?t of ~~lI!-S TD w/~l f ~ _
(~iy) (Sts»)
and 1 resided at ~s Wqs!~f /~Y~ /y ~l~ ---l--• However 1 hav~ chanqsd my domidl~
(St~eet ued Number)
ro and am end have been a bona fide resident of the State of Florida since day of
_~_,~ANu_~T_~ , 14?V and 1 roside at ~~6d M~R~iT7TF.t°R~~~
(Sheet and Number)
PUIrTST- 1 t!c i,E, fcA~ 33 ~SD
I~ORT NdtCE, SAINT tUC1E COUNTY, ~iORIDA . ~
and this statement is b be teken as my daclaration of Ntize~ship, actusl legal residenoe and domicile in the State of Florida.
(I~sert hero any pertinent fects, such as sale of property or buainess, or ~ellnquishment of employmsnt ~
at former domicile, removal of family to nsw domicile, purchase of home, etc.)
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~IM jS 33 ~
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E 32
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~ 1 FURTHER GHtTIFY that I will comply with all oN~sr requirsrr~nn of e le~a) residsnt of this State.
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1 FURTHER CERTIFY that I have no intention to retum to my former domicjle, and ! infend fo remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIOA, permanently.
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~ (Name) P e { ~?t /f . ~ ~ ; s s
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~ (Addres:)
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~ ,~~ttii+s~~;r;u,r
~ ;~'`.~r~ hq~,~ ~y~oribed before me this ~ s day of 19~
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~ ~ ~n '4 - ~ ~T Notary Public
~ ~ ~ ' O.C. My ~ommission expiret
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