HomeMy WebLinkAbout2071 ~ ~
Deciaration ot Domlcile and Citize~ship
TO THE STATE AND COUNTY TAX ASSESSOR,
2~~5542
Sl. LUCIE COUNTY, FIORIDA. '
This ~s my dedaration of Dom~cile and Citizensh~p in the State of Florida that 1 am f~t~ng this day in accortlance and
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~n conformity with Chapter 222, Section 222.17, Florida Statutes "
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I was formerly a legal resident of S0- ~ r~~ ~ C TC K~ S_ .
(C~ry) (State)
and 1 resided at 3~ N ~•S'~ ~ i Q~
_ _ However 1 have changed my domiCile
(Street and Number)
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ro and am and have been a bona fide resident of the State of Florida since ~C day of
Nf?v2ci1~1~1' 19__ `
, 7 L , and I reside at _ 1 ~ S ~ ~ ~ II ~C ~'F
(Street and Number)
PORT 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 sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicife, purchase of home, etc.)
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E 205542
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~ I FURTHER CERTIFY that I will comply with all other requirements of a lega) resident of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domic,ile, and 1 intend to remain in FORT ;
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~ PiERCE, SAINT LUClE COUNTY, FLORIDA, permanently.
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~ {Name) 5 T'a-6~ ~f `
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r Swocp;to and subscribed before me this -~~r day of t-~~. , 19~.
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~ ~ • `~~;i~K CtltZWY.COURT Notary Public
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~ ~Y. ' ^j • ~~?T D.C. My Commission ex ires ~
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~ (To b~ tiiicut~d in dupliuts and oripinal ~iled with Cf~rlt Grcuit Court, snd dupliut~ with Tax Ass~ssor.)
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~ ~1~I 2067 ~
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