HomeMy WebLinkAbout2307 ~ i
~ala~atlo~ o! Domiall~ a~d Citls~ihlp
TO THE STATE AND GOUNTY TAX IISSESSOR,
Sl . lUC1E COUNTY. FIORICA: ~ i
3J
This i: my d~cla~~tion of Oomicila •nd Citis~~ship in th~ Stat~ of Florida th~t I am filinq thii day in aooordano~ and
co~formity with Chapter ?22. S~ction 222.17, Florid~ St~tut~s.
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1 was fo~merly a 1e9s1 roside~t o ~~2~ /"t - -
(City) (Staro) ~
and 1 res~dad at 'e~However 1 have chan~sd my domic3le
(Street and Number)
to and am and have bee~ a bona fide resident of the State of Ftc~ri since ~ Z-~ day of
_ , 19 /~snd I ~eside at ~ ~ ~e - ~
(Street and Number)
iORT PI~CE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(lnsert here any pertinent facts, suth es sale of property or business, or reli~quishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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f11E6 AlID NfCOR~ ~
fT.1.fiC1f COINITT ~
itOCER P01TRAt
CLERK C1RCUIT COWt1 J`
. RECORO YflUFtE~
.YN 15 12 ~7 Pfl'1~ . .
, . 203'73~
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I FURTHER CERTIFY that I will compty witfi all other requirements ot a Isqal resident of this Stat~.
1 FURTHER CERTIFY that 1 have no intention to return to my fo~mer domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~:=~;~~~~lpr''~i~id wbscribed before me this day of ~ , 19~.
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. ,.,r,,, ~ Notary Public
By
~n~`~. .C D.C. . My Commission expires
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(Te b~ uc~a+t~d ie dvplicab ~nd ai4inal Al~d wwiM~ Cls~lc Ckaik Cwr1, ~nd dupiisst~ wHb Tix A~era
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