HomeMy WebLinkAbout2728 2t1~~t)~
D~cla~ation ot Domiail• and Citls~nship .
TO TME STATE AND ~OUNTY TAX ASSESSOR. •
Sl. lUC1E ~OUNTY. FlOR10A: .
This is my declsration of Oomicile and Citizenihip in the Stat~ of Florida that 1 am filinq this d~y in acao~dance a~d
~n conformihr with Chapter 222, Section 222.17, Florida Statutes.
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I vras formerly a tegal resident of .
(Ciy) (Sta»)
and i resided at _ _ However I have chan~ed my domic+le
(Street and Numbe~)
'o and am and hav~e been a bona fide resident of the Stste ot Florida sinoe dsy of
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, 19~, and I ~eside at .
~ eet and Number) _
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to- be taken as my declarotion of citizenship, actual legal residenoe and domicile in the State of Florida.
(Insert here any pertinenf fads, such as sale of property or business, or relinquishmer~t of employment
at former domicile, removal of family ro new domicile, purchase of home, ett.)
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204033
~T.LIiCtE COYNTY Fl~.
IIOCER'0ltRAi s
CIERK CIRCUIT COYRTD~
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RECORD VE1l~P1E0~.~•~L
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€ I FURTHER CER~IFY that 1 will oomply with a!I other requirementt of a leyal resident of thi: State.
I FURTHER CERTIFY that I have no intention to retu~n to my former domicj~e, and 1 intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. Gpor~ ~ C G a S'~
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(Name)
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Sworn,tq:eti~l:sybxribed before me this ~ day of , 19~.
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~ ; Notary Public
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~ By: ; ~ D.C. My Commission expires
~ ~t,~,/~.3 :~~2
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~ (t~ . W~~uplieah and e~i~inal Al~d wi~ t~C ~ CouN, and duplieaN wilh Tax A~~ora •
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~ . , ~ - aao~ 189 2720
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