HomeMy WebLinkAbout2160 Declaration ot Domicile and Citize~ship
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TO THE STATE AND COUNTY TAX ASSESSOR,
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Sl. WCIE COUNTY, FLORIDA `
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Th~s ~s my declarahon of Oomiule and Citizenship in the State of Florida that 1 am fil~ng this day in accordance and
~n conformity with Chapter 222. Section ?22.17, Florida Statutes. ~ i
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I was formerly a legal resident of ~ `t''r `~~C~' _ _ ~ '~L % ~ -
(City) , (State)
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a~d I resided at/~ ~ j~_ However 1 have changed my domitile T
(St~eet and Number) ~ ~
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+o and am and have been a bona fide resident of the State oi Florida since ``~O~ ~ y of
" r C~L ~ , 19I Q ~70 .7i / CQ-Gyrc/ G-Ll~C - i
, and I reside at ~
(Street and Number) ~
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residen:e 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, ~emoval of family to new domicile, purchase of home, etc.)
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' I FURTHER CERTIFY that I will comply with al) other requirements of a legal resident of ihis State. ~
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~ 1 FURTHER CERTIFY that 1 have no intention to return to my former domicjle, and I intend to remain in FORT ~
~ FIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently. ~
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~ . '';t , (Name)
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~ ~ _ :i'~•#~~~ Warren L. Creasey
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Swom ro eriii subscr~bed before me this _ _ day of _ _ _ _ _ _ _ . _ _ , 19~1.
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` R ER POITRAS
~ K CIRCUIT URT Notary Public '
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BY D.C. My Commission expires -
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(To be ex~cut~d in duplicate and oripin'al filsd with C{~rk Circuit Court, ar?d duplicate with Tax Ass~ssor.) ,
3-~ s~R~ 190 2156 ~
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