HomeMy WebLinkAbout2512 y~
D~la~ation ot Oomicil• and Citi=~nahip
2(: ~
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FtOR10A:
This is my detlaration of Oomicils and Citi:enship in the Stats of Florids that 1•m filinp thi: day in aoo~tdanu •nd
~n conformiy with Chapte~ 222, Section 222.17, Florids Statute:.
•/~~y ~ ~ fi
I was formerly a legal resident of 4 _ /
- - ity) (Stste)
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and I resided at ~__L~~~L~ " V~ However 1 hsve chsn~ed my domic~le
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since . GL ~ day of
. 19~~ , and .1 reside at ~
(Street and Number)
FORT r1ERCE, SAINT LUCIE COUNTY, HORIDA
and this statement is to be taken as my declarotion of citizenship, actual lagal residence a~d domicile in the Stab of Florida.
(Insert here any pertinent facts, such as sale of p~operty or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
,
.
~ml,a~`. ~~-~s'',,o~ iT-~ IE EC
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C~f~O~ER i0 TR~~ ~y,.n~
Ri~OAD Y[RRfi~p
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iie4~~li
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~ I RJRTHER CERTIFY that I will comply with all other requirements of a leyal resldsnt of this State.
~
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~ I FURTHER CERTIFY that I have no intention to returR to my former domi~ile, and t inte to remain in FORT
~ ~IERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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s '-~d~subscribed before me thia day of ~ ~ _ , 19~
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F~.-~O., ~
~ ~"'''rr,A00ER rOITRAi
~ CL~RK CIRC R COURT Notary Public
~ By ~ ~ D.C. My ~ommission expires
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(To b~ ~x~cufod in dup{icat~ and ori~inal fil~d wilh q~~ic Circuit Court, and duplkah wHb Tax ANa~ora
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