HomeMy WebLinkAbout1546 J~
Declaration ot Domicile and Citizenship
TO TNE STATE AND COUNTY TAX ASSESSOR, ~~j ~~~~I
51. WCIE CQUNTY, FLORI~A:
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This ~s my declaration of ~om~cile anrl Citizenship in the State of Florida that I am filing this day in accordance and
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;n conformity with Chapte~ 222, Section 222.17, Flo?ida Statutes. ~
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t was formerly a leqal resident of W_.~ _ e- e'
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(Ciy) (State) a
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and 1 resided at ~ _ W~ E'. However t have changed my domiGle ~
(Street and Number)
ro and am and have been a bona fide resident of the State of Florida since~ l~l.~- _ day of
, 19__ , and I reside at ~ ~ 0 ~ l ~'ti ~ ~ l) ~ _ - - ~
(Street and Number) +
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as safe of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.3
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~ 1 FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
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I FURTHER CERTIFY that I have no intention to return to mer domic,ile, and 1 intend to remain in fORT
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ Sworn to and subscribed before me this day of ___-______~t 14~ ~
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~ ~~+i ~ ~ jt C~URT Notary Public
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' K ~ f'~!~~L D.C. M Commission ex ires _ _
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,~{_'3w dupliut~ ar~d oriqinsl fil~d with Cl~rk Cjrwit Court, and dupliut~ with Tax Ass~saor.)
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. ~ ~ ~.~0 1543
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