HomeMy WebLinkAbout1742 Declaration ot Domicile a~d Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR, ~~S~UO
Sl. IUCIE COUNTY, FlOR1DA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing ihis day in actordance ar?d
in conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legaf resident of _ ;
- - - -
(City) (State) ~
and I ~esided at ~O "t~ - - _ _ . However I have changed my domiCi~e
(Street and Number)
ro and am nd have been a bona fide ~esident of the State of Florida since day of
~ ~ .
~ / ~t.l~t.-Q
- 19.~0 and I reside at - - - - {
, (Street and Number) ~
,
FORT PIERCE, SAINT LUCIE COUNTV, FLORIDA ;
:
and this statement is to be taken as my declaration of citize~ship, actual legal residence and domicile in the State of Fiorida. `
(Insert here any pertinent facts, such as sale of properiy or business, or relinquishment of emptoyment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
~ I FURTHER CERTIFY that I have no intention to return to my former domic,ile, and I intend to remain in FORT
~ PIERCE, SAINT IUCIE COUNTY, FLORIDA, permanently.
~
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~ (Name)
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(Address)
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~ Swom to and subscribed before me this day of l<< , 19~
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CL~;EJR~WT COUIE~ ry
Nota Public
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~ gy - D.C. My Commission expires
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~ (To b~ sYiarlld iS'~Ipfl~ and ori~inal filsd with CIlrlc Grcuit Court, and dupliut~ with Tax Ass~s~or.)
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