HomeMy WebLinkAbout0415 + Declaration ot Domicile and Citi:ee~ship ~ 0 6 5 3 e
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TO THE STATE AND COUNTY TAX ASSESSOR.
Sl tUC1E COUNTY, FIORI~A
Th~s ~s ~~y detlarat~on of pomiule and Cit~zensh~p ~n the State of ~3a~~da that 1 am f~3~ng shis day ~n accardance and
n conform~ty w~th Chap~e? 222, Sect~on 2?2.17, Fiorida Statutes
I was formerly a le~al resident ot ~~T~T_~ ~f_=/L:%2`A
(City) (State)
and i res~ded at i Howe~er I have changed my domiciSe
(Street and Numberj
to ancf am and have been a bona fide resident of the State of Flo~ida since ,~i~~ ~ 1 ;iay ~t
. 19~G' , and 1 reside at ~ ! C ,~.+1 ~14 /~'~Q~___
~Street and Numbe~)
FORT PIERCE. SAINT LUCIE COUNTY, RORIDA
and this statement ~s to be taken as my declaration of citizenship, actuai legal residence and domic.ile +n she State of Flor~da. ~
(lnsert here any pert:nent facts, wch as saie of property or bus~ness, or refinquishment of err,pfoyment ~
at former domicile, removal af family to new domiciie, purchase of home, ett.) 3
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ftlEO AND RECOaDE1 .
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€ 1 FURTHER CERTIFY that 1 will comply with all other requireme~ts of a legat residernt of this State.
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` 1 FURTHER CERTIFY that ~ have no intention to return to my former dom~c,ile, and I intend to remain in FORT
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~ ~:ERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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: (Na Richard J . Toews
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- Sworn to and subscribsd before me this Q!~__ _ day of _ , 19
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~ '~lrlt COURT- Notary Putf ~c
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~ Sy / ' - D.C My Commission expires _
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~i if+ ~ciA~ I~ dapNtaN snd oripinal ~il~d with Cbrk Circuil Cou~t, •nd dupliuN witl~ T~x A~sso?.)
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