HomeMy WebLinkAbout2566 v i E
~lu~tlon of ~omiali~ and Citlsfnshlp
TO ~HE STATE AND COUNTY TAX ASSESSOR, ~
Si. lUC1E COUNTY, FtORIDA:
2C 3911
This i: my detlar~tion of Oomicile and Citis~nship in th~ Ststs of Florida that i~m filirq this day i~ aooo~darw~ and
in oonformity with Chspter 22?, Sectio~ 222.17, Horid~ Ststut~s.
1 was formerly a Ipsl rssident of -~s~~
(~ity) . (Stab)
and 1 ~esided at ~D~~ ~ . Howevet I have chanqed my domkile
' (Straet and Numbe~)
to and am and havs been a bona fide resident of the Stats of Florida since ~Y ~
_ , 19~, a~d 1 roside at ~Go 9' l~~~ ~
, ~ (Street and Number)
I~T r1ERCE, SAtNT LUCiE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual Iagal residenoe and domicile in the State of Horida.
(Insert here any pertinent facts, such as sale of property or buainess, or relinquishment of e~»ployment
at former domicile, romoval of family to new domicile, purchase of home, etc.)
f ~ED AMO R
S~~ R06ER~
O~tKTA~1~
RE~O~o Ki?E~ T+I~.~
~r 18 1 ~ ~o ~M ~
2Q39ii
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1 RJRTHER GERTIFY that 1 will comply with sll oM?er requirtmsnb of e lepal resident of thi: Stats.
1 FURTHER CERTIfY that I have no intention to retum to my former domicjle, and I intend to remain in FORT
PiERCE, SAINT LUCIE COUNTY, FIORIDA, permanently.
,C i~/(•c~ ~1
(Name)
.
(Hddress)
~ ~ -
Sw~r~,~o'et~d sul~scribed before ms this day of 19.~ .
:ti ~ urNr~;~
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'~ra~~
'r ~ Notary Pu51it
By= -''fr~ O.C. My Commission sxpir~s
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