HomeMy WebLinkAbout0152 Declaration ot Domicile and Citlsenship
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FLORIDA:
This is my declarotion of Uomicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florids Statutes.
I was forme?ly a legal resident of __1~~a1 _ ,~l.n~~-vr_.o~~t~ _
(City) (Sta»)
and 1 resided at _D~Q~P~ O_~~il~~ However 1 have chanqed my domidle
. (Street and Numbe~) ,
ro and am and have been a bona fide resident of the State of Florida since _~~l~.Gn~~t__l.~
~T ~9~~ day of
1 191~, and I roside at ~ ~ ~ ~ . -
(Street and N~~) ~
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FORT PIERCE, SAINT lUCIE COUNTY, RORtDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, rerrwval of family to new domicile, purthase of home, etc.)
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ST~`EUCIE COUMIY flA.
ROCER P4tTRA8
CIERK C~aCUIt CO CU
RECORO VERIFIE~
FEe 8 9 s5 AN'1l
204320
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~ I FURTHER CERTIFY that I will comply with all other raquiramenh of a leya) resident of this State.
~ I FURTHER CERTIFY that 1 have no intention to retum to my former domicjle, and 1 intend fo remain in FORT
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA,'permanently.
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~ (Name)
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3 (Address)
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~ `~~irt~)t~f~•err~~suburibed before me this day of ~ , 19_..t_.
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~ .v...~RT Notary Public
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~ BY D.C. My Commission expires
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~ (To b~
~~xiaitsd~~ fn duplicat~ and orioinal NIO
Q witl~ Cl~lc Urcuif Court, and duplir.af~ wili~ Tax Ass~or.)
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~ooK 190 152
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