HomeMy WebLinkAbout1596 y`
DeClaration of Domicile and Cttisenship
2052~~~
TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FLORIDA:
This ~s my decla~ation of Dom~cile and Citizensh~p in the State of Florida that 1 am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of !./`?/e~'- /4 ~~~E_ __~~~G/No/~__ _ ,
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and 1 resided at '-D /~LQ7t~1~S~~ST_.. /7?~/ _ However I have changed my domi~ile
(Street and Number)
ro and am and have been a bona fide resident of the State of Florida si~ce day of
!1 ~YE~ ~v /2 r
_~L`GEi?~l,BER , 19~0 , and I reside at /,~~o_ ~,E_~~eL ~
(Street and Number)
.G lJC ~E
FORT PIERCE, SAINT IUCIE COUNLIf, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Inserf here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Fl~EO ~kC FECQ~~EQ
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~ 1 FURTHER CERTIFY that I will mmply with all other requirements of a(egal resident of this State. ;
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~ I FURTHER CERTIFY that 1 have no intention to return to my former domiCile, and 1 intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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, ; ~~i~i!ti~o',`~ ~bsc~'bed before me this - day of . 19
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K'C~CUIT COURT Notary Public
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By - ~ D.C. My Commission expires
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~ (To bs ~xecvt~d in duplicats and o?i~inal ~iled with Cl~~ic Circuit Court, and dupliut~ with Tax Asssssor.)
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