HomeMy WebLinkAbout0295 20442;~ ~
Declaratlo~ ot Oomicile and Citizenship }
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORiDA:
This is my declaration of ~omicile and Citizenship i~ the State of Florida that 1 am filing this day in accordance and
~n conformity with Chapter ?22, Section 22?.17, Florida Statutes. •
1 was formerly a legal resident of
- - - _ . _
~C;ty~ (State) ~
s~r. ~
and 1 resided at _ Q _~,11~ / 0_~ _ _ _ _ _ _ . However 1 have changed my domitile
(Streef and Number)
S~'
to and am and have been a bona fide resident of the State of Florida since ,~Il - day of
V ;
, 1931 ~(2 S -`1'1-_~a ~ - -
_ _ and I reside at
(Street a~d Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORiDA
and this statement is to be taken as my declaration of citi2enship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of p~operty or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.) ;
;
20442:~
~ E11.E0 AN ~00xt ~S~A.
S~• ROCER POti ~
CIERR fRif 1E~~CQ
RECOR~ Y ~
~0 9 100 ~M'11 ,
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i FURTNER CERTIFY that I will comply with all other requirements of a legal resident of this State.
~ I FURTHER CERTIFY that 1 have no intention to return to my former domicile, and I intend to remain i~ FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORI~A, permanently.
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~ } . ~~~'~_~~Ql( L~Yt % _ ~ ~1 C 3 .
~ ``~`.~~~~t~nn?~~,,,~. (Name)
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Q' = ~~,'~„~~"~I`/~ i : . (Address)
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~ I~ before me this da of _ , 19~.
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~2 ~~r,,e~~- Co.~
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~ RBGER
Ji~
~'~6As
~ CLERK CIRCUR~ COURT - Notary Pubiic .
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~ By D.C. My Commission expires
~ (To b~ ~x~cut~d in duplicat~ and ori~inal filed with Cl~rk Urcuit Courf, snd dupliut~ with Tax Assessor.)
~
; ~ R 190 294
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