HomeMy WebLinkAbout1393 Y
Declaratlon ot Domicile and Citize~ship
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FLORIDA:
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ih~s ~s my decla~ation of Domiule and Cit~zenship in the State of Florida that I am 4it~ng this day in accordance and
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~n conformity with Chapter ~22. Section 222.17, Florida Statutes
I was formerly a legal resident of ~ . _ _ - - - -
~C;ty~ (State)
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and I resided at /j t g. ~/~'7~"`` However I have changed my domicile ~
(Street and Number)
to and am ~d have been a bona fide resideM of the State of Florida since - day of
~rn~ , 19_~~ , and I reside at ~_7~ ~ - -
A (Street and Number
FORT PIERCE, SAINT IUCIE COUNTY, FLORIDA
and this statement is to be taken as my declarat~on of citizenship, actual legal residence and domicile in the State of Florida.
(tnsert here any pe~tinent facts, such as sate of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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QOCE~ ~OtTRAS
CLERII t+dCUR COURT
RECQRD YEfi~F1E~~c'~
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~ I FURTHER CERTIFY that 1 will comply with all other requiraments of a legal resident of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_
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~ r~ (Name)
~ : ~f~~/l~ro/Y
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'~~f'j ~ ~ a,'a11~'d~.s~bscribed before me this ~ day of ~-~-~l~ - . 19~
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~ ~ ~ ~OITRAS - -
~ , CLERK CtRCUR COURT Notary Public
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By S~ _ ~ _ D.C. My Commission expires _ _
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~a (To b~ ~x~cut~d in duplic~t~ and ori~inal fil~d with Ci~ric Grcult CQUrt, and dupliut~ with Tuc Ass~sso~.) M
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