HomeMy WebLinkAbout0245 ~c~43~
Declaration ot Do~nicile ~nd Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, '
Sl. IUCIE COUNTY, FLORIDA:
This is my declaration of Oomicile and Citizenship in the State of Florida that 1 am filing this day in ectordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of . . _ __C!~
/ _ ~ _Q--- _ --_-__~s~_ r i '
(Ci (State)
r~ S~, c h~. ~ ti.d +
and 1 resided at _ _ _ _ _ _ _~_n, ~
_ Nowever 1 have changed my domiti~e i
(Street artd Number) i
fo and am and have been a bona fide resident of the State of Florida since day of ,
_ _ / s~ _ . _ d O OSO ~J ~Y~ j
_ 19.~ ~ , and 1 reside a~ _A---- _ - - ,
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citi=enship, adual lega) residence and domicile in the State of Florida.
(Insert here any pe?tinent facts, such as sale of property or business, or relinquishme~t of employment
at former domicile, removal of family to new domicile, purchase of home, etc.) ;
~ ~'a~ ' 2(}4381
~ ftlEO ~NO RECpROEp
tL lNC1E CO~NTY f/A. ~
ROCFR P0ITRAS
CtERK CIRCUIT COtMT
- RECORB YERiFtfO
FEO 9 10 0~ ~h'11
I FURTHER CHtTlFY lhat 1 will comply with ail ather raquirements of e leyal resident of this State. ~
1 FURTHER CERTIFY that I have no intention to return to my former domicjle, and i i~tend to remain i~ FOR7 ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permansntly. ~~~~/fQ~/ ~ x'U~~G i
s
(Name)
.
o GI~~~•
(Address)
- ' ~ /...i
,~~,~.~~~SWdrq,tq and subscribed before me this day of , ~q
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. ~~ItCO Notary Public
_ ; * • _
":BdA~ , ~ D.C. My Cammission expires
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tTo~ b~~1H~d in duplicah snd ori~inal fil~d with C1~Ic Grcuit Court, and duplicat~ with Tax Ass~ssor.) ~
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