HomeMy WebLinkAbout2491 O~alaration ot Domlall• ar~d Citis~~s~ip
TO THE STATE AND tOUNTY TAX /1SSESSOR, s~,
51. U1CfE COUNTY. fIORiDA:
Thii i• my declaration of Domicile and Citi:~n~hip in th~ St~ts of Florida that 1 am filirp this d~y in sooord~no~ ~nd
~n conformity with Chapter Z24, Sectio~ 2~2.17, Florid~ Statut~:.
,
I was formerly a Isqa) resid~nt of s~~ ~ _ i C~/' C~ /a
~ (City) ~ (Sbh)
~ c/ 0 /d 0~f'i 1 iv 6 H~~
and 1 rosided at ~
However 1 have chanQsd my domitile
(Sh~et and Number)
ro and am and hsve been a bo~a fide resident of the State of Florida sinoe dsy of ,
---.---~-o~ . 19~~'1, and 1 reside at ~~_!g ~ A L~ ~9
(Street and Number)
I~ORT MER~E, SAINT LUCIE COUNTY, IRORIDA
and this statement is b be taken as my dnclsration of citizenship, sct~al legal residence and domicife in the Staro of Horida.
(Insert here any pe~tinent facts, such as sala of property or business, or ~elinquishme~t af employment .
at former domitile, r~moval of family to new domicile, purthase of home, ett.) ~
t~ltlC F ~OUNn ~
CIER~~C~~C~WY~a
RE~OI1o vERiFiFO ~~T ~ .
~ tl 9 ~ AM'11
203~J~
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i I R11tTHER ~ERTIFY thst I will aomply with all other rsquirorrknts of a Is~a1 resident of this Siste.
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I FURTHER CERTIFY that 1 have no intention to retum to my former domitile, and I intend to remain in FORY
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~ ; . ~ . (Name)
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~ ; _ ~ibad before me this day of ~ , ~9~
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~ ~~'~~r Notary Public
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~ BY D.C. My Commiision ~xpirK
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~ a. b..:.w»a M du~lk.r. .~+a o~lnal Nl.a wi~ ci~C cl~h c.w+, .~a d~u~.t. w~ T.x A...«..a
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