HomeMy WebLinkAbout0322 Declaratlon ot Domiciie and Citizsnship
TO THE STATE AND ~OUNTY TAX ASSESSOR, 20~~~~
51. IU~IE COUNTY, FLORIDA: ~
This is my declaration of Oomicile a~d Citisenship in the Stste of Florids that I am filinq this day in ecoordants and
~n conformity with Chapte? 222, Sectian 222.17, Floride Ststutes.
1 was formerly a le9el resident of ____~!~~a~_ _ ~ ~ -
(CitY) (Staro)
and ! resided at However I have chan9ed my domkile
(Street and Number)
to and am and have bee~ a bona fide resident of the State of Florida since day of
---1~/Q (!_~"w[_~L' - 19.~-~, and I reside et _ ~
(Str and Numbe?)
FORT MERCE, SAINT LUCIE COUNTY, f~ORIOA
and this statement is to be taken as my declaration of citizenship, actual leqal residence and domicile in the State of Horida.
(Insert here any pertinent facts, such as sala of property or busi~ess, or relinquishment of employment
at former domicile, removal of family to new domicile, purchass of home, etc.)
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~ I RJRTHER CERTIFY that I will oomply wltfi all other requlramentt of a lepsl resident of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domiCile, and { intend to remain in FORT
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~ PIERCE, SAINT IUCIE COUNTY, FLORIDA, permanently.
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i ~ SyjpM~~trq~ai~d _s0~rscri6ed before me this l ~ day of ~ , 19~
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_ L~ ' -~a~ ~2"°`•° = -
. . '~C,~ ~ ~~11~f Notary Public
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~ ~Y ~ O.C. My Commission expires
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~ Ro b~ uc~d in dupliut~ and oriqinal fil~d wMh CINic CircuH Courf, and duplk,al~ wi* Tax A~sr.) I
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'73
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