HomeMy WebLinkAbout0025 ~e~laration ot Domicile a~d Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
206~90
51. LUCIE COUNTY, FIORIDA:
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This ~s my declaration of Dom~cile and Citizenship in the State of Florida that I am filing this day in accordance and ~
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~n conformity with Chapter 22~, Section 222.17. Florida Statutes. F
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I~SG!/E6 _ E:,cl-- L~`'~C-_ s
! was formerly a legal resident of _ _ - s
(C;ty) (State) ~
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and I resided at /t (7l~fF ~D y. Nowe~er I have changed my domicjle
(Street and Number)
+o and am and have been a bona fide resident of the State of florida since ~ _ day of
~ F~T , 19__7~~, and I reside at ~/~~CE ST
(Street and Number)
FORT PIERCE, SAtNT LUCIE COUNTY, FLORIDA ,
and this statement ~s to be taken as 1my 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 famity to new domicile, purchase of home, etc.)
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LUCIC ~ R p ' i
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- A CLERK Cjk~U1T
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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 domicjle, and I intend to remain +n FORT
~ °IERCE, SAINT LUCIE CUUNTY, FLORIDA, permanently.
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~ (Name) ~f
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: (Address)
rv Swom to and subscribed before me this --L~ - day of _1~!L<_ _l~-=-- 19~
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. •ItOi~R ~ 401TRAS - - - -
~CLFRK C1RClJIL~COURT Notary Public
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n~ By - L-____-_ _ D.C. My CommissiOn expires _
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(To b~ ~cdoufMl in duplicste snd original filed with Clerk Circuit Court, and duplicats with Tax Assessor.) ~
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