HomeMy WebLinkAbout2726 2( ) 4t)31
D~al~~atio~ ot Oomiail• a~d Citls~nahip
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY. FIORI~A:
This is my declaration of ~omicile and Citi=en:hip in th~ St~~e of Florida that 1 am filinq this d~y in aooordanu and
~n conformity with Chapter 22?, Section Z22.17, Florida Ststut~s.
~~G~ n
I was formerly a legal resident of v -
(City) ab)
+-t.~' -~~'Y"-'-~'`~~" However I hsve chsn~ad my domit,~le
and 1 rosided at
(Street and Numbe~)
to and am and have been a bona fidR resident of the State of Florida since t ~ day of
~~t Gc~ ~ " .~7' `-~1Ca~c.?ort~ i1L~-~~
~ , 192 , and I reside at
(Shaet and Number)
FORT PiERCE, SAINT LUCIE COUNTY, RORIOA
and this statement is to be take~ as my declaration of citiZenship, actual legal residence and domicile in the Staro of Horida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
" 204031
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sT~iuCiE CO
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ROCER POi?RAS
CI,ERII CIitC11tT COYitT ~
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I RJRTHER CERTIFY that I will oomply with all other requirementt of a leyal resident of thts State.
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1 FURTHER CERTIFY that ! have no intention to return to my former domicile, and I intend to ?emain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. /~o-tv~ ~Ge-~~/f~.-~.a1~
/~%L.~a-, ~~Ct ~
~ Name)
s; .1 ~ lrF."7'"'Y CZ-s L~
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~ (Address)
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~ Sworn to a
~ esgl. subsuibed before me this day of , 19 .
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I~'~ Notary Public
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By _ , D.C. My Commisiwn expires
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~ Ro i~ ~ k.F. a~a ori~inal A~.a witl~ a..k ara~M cou~t, .nd d~ik.~. «?iti~ T.x A....~o.a
~ f'~':~ss~utut~~~~
aoaK189 2718 ,
Na. 13
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