HomeMy WebLinkAbout2729 o~cla~atio~ ot Domici~• and Citis~nahlp 2t141)3~
TO THE STATE AND GOUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, ~IORIDA:
This is my declaration of Oomicile and Citizenship in th~ State of Flaid~ that 1 am fili~q this day in acao~danu and
~n conformity with Chapte? 222, Section 222.17, Flo~ids Statut~s.
I was forme~ly a legal resident of _-_~~1~~~~~ ~ _ Ej -
(Ciy) (Sta»)
and 1 ~esided at -_'1LG /T~~ However 1 heve chanQed my domitile
`g / (Street and Numbe~)
to and am and have been a bona fide resident of the State of florida since _ dey of
_ , 19~, and 1 reside at Gy~l~ ~/~~N-~~~ A~~
(Sheet and Number)
FORT PIERCE, SAINT •LUCIE G4UNTY, RORIDA
and this statement is to be taken as my declarotion of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here any pe~tinent facts, such as sale of property or busineu, or ~elinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.) ~
~~0~'1~' ~S>E/~J~ ~X~~`!~"/0/1~
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' F tE0 AKp RECORQ~R .
~ ~OCER
~OIT~/~iE 14
CLERK CI~CUIT COURT
RECORD YERIFIEd
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~ 1 FURTHER CERTIFlf that I will oomply witfi all other requireme~tt of a leyal resident of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domic,ite, and I intend to remain in FORT
PiERCE, SAINT lUC1E COUNTY, FLORIDA, perma~ently. ~Q~~y rv~~` ~ r
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~ (Name)
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~ Sworn to and suburibed before me this day of , 19 7~.
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~ RT Notary Public
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~ By D.C. My Gommisaion expires
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-r.•-~~fy:. s
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~ ,~'rM. ~ iiM lWpliut~ ~nd oriQinal Alsd ~vi1h C1Kit Gra~f Cou~f, and duplicai~ wiTh Tax A~sw~.)
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