HomeMy WebLinkAbout0294 Deciaration ot ~omicile and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FIORIDA:
This ~s my declaration of Uomicile and Cit~zenship in the State of Flo~ida thst 1 am filing this day in accordence ar~d
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was forme~ly a legal resident of L..~ d~~~~~ _ -
(City) (State)
and 1 ~esided at ~/v 0 S lv'QJ ~~r? ~ J'/~' C_• _ However I have changed my domiCile
(Street end Number)
to and am and have been a bona fide resident of the State of Florida since _ _ day of
_ ~a~ rv e , 19_'7/ , and 1 reside at 7c_~ ~a-- ~~d ~1 sJ ot ~
(Street and Number) ~ ~ .
FORT PIERCE, SAINT LUCIE COUNTY, R,ORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Flo~ida.
(Insert here any pertinent facts, such as sale of property or business, ar ~elinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
~ dh+ d YG~f~•cd ~01 la ~~r ~o~~~ ~V~e~~i~~~ /Ft` ltTl. ~r
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~ FEe 9 204424 :
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~ 1 FURTHER CERTIfY that I wil) comply with all other requirements of e{egal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiGle, and I intend to remain in FORT
~ ~IERCE, SA!NT LUCIE COUNTY, FLORIDA, permanently_
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~ .......;JG (Name)
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~rrt'a~ subscribed before me this day of _ , 19~~
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~ Roc;~ roirnws
~ K CIRCUIT COURT Notary Public
~ B t D.C. My Commission expires '
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Ro bt ~xecvted in dupbcate and ongmsl filsd w~th CIKic Grcuit Court, snd duplicaH with Tax Ass~ssor.) I,
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