HomeMy WebLinkAbout0695 ~
~eclaration ot Domicile and Citisenship 2~4'~iE~
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE ~OUNTY, FIORIDA:
This is my dectaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance a~d
~n conformity with Chapte~ 222, Sectio~ 222.17, Florida Statutes.
I was formerly a le9al resident of ~
_
~ (~y) (State)
c" S T-
and 1 resided at . Howevcr I have changed my domiCi~e
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _ day of
.
~ ~ _ - 19~_D and 1 reside at ~ ~ t K~~~ y
(St~eet and Number)
FORT PIERCE, SAIN? tUC1E COUNTY, fIORIDA
~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida. i
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of emp~oyment
at former domicile, removal of family to new domitile, purchase of home, etc.)
i
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A ,1(~?t''~_ 1Z %~.e~l~~~
2t)4`716
Fi~eo ~?~o aECOa~Eo
ST. R CER
POITR S~A
CLEttK CIRCUIT COURT
RECORD YERtF1E0
FEe 16 I 2~ PM't I
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g I FURTHER CfRTIFY that I wil! oompty witfi all other requirementa of a leqal resident of this State.
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1 FURTHER CERTIFIf that I have no intention to return to my former domitile, and 1 intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. Chester DeVi.to
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~ (Name)
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S~~/ ~'~.r..~~ ~ ~
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f, t~?dd~e::)
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~ Swom to and subxribed before me this ~ day of ~ , 19~.
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~ : . ~tQ~ Notary Public
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By ' D.C. My Commission expires
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~ ~ ~in,~iiplieaM and oripinal ~it~d wilh CIKIc Cirwh Coue~, and dupliuN with T~x Ass~sror.)
~:tt~~,,.~;~~~~~ ~ ~ 1~0 692
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