HomeMy WebLinkAbout0628 ~
DeCl~~ation ot DomiCile and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. WCIE COUNTY, FlOR1~A: Z(?~~~2 `
,
This ~s my declaration of Domicile and Cit~zensh~p in the State ot Florida that I am filing this day in accordance and
~n conformity w;th Chapter 222, Section 222.17, Florida Statutes. ~
; was formerly a iegal resident of ~1~ ~ ~~{`~C _ j~_~~..2 ~ _
(City) (State)
and I resided at . _ ' However I have changed my domicjle
(Street and Number)
~o and am and have been a bona fide resident of the State of Florida since E.~. l~~~ der-•ef~
~j_ ~s c.e-~ ~ ~-t~~te z c~_ .
- , , and I ~eside at
(Street and Number)
FORT PIERCE, SAINT LUClE COUNTY, RORIDA
and th~s statement ~s to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pert~nent~ facts, such as sale of p~operty or business, or relinquishment of employment
at former domicile, removal of fam;ly to new domicile, purchase of hame, etc.) 3
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FILEO ~HO RECORDEO
§~'.lqC1E COWITY fU.
~CCCEh Pt~I~RAS
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~ I FURTHER CERTIFY tfiat I wil) comply with all other requirements of a leyal resident of this State.
~
~ 1 FURTHER CERTIFY that 1 have no intention to retu~n ta my former dornic,ile, and 1 intend to remain in FORT
~
PIFRCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ Swom to and subscribed before me this ~ _ day of 19
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~ gY: , ~~D.C. My Commission expires -
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"~T ~ i~q dvpliut~ a~d oripieul fil~d with C1Kic Cireuit Court, and du iub with Tax Ass~s~.)
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