HomeMy WebLinkAbout0791 - i
De~laration ot Domicile and Citizenshlp 2 0 6 7 6~
TO THE STATE AND COUNTY TAX ASSESSOR,
51. tUCIE COUNTY, FlORIOA:
;
,
This is my declaration of Domicite and Citizenship in the State of Florida that I am filing this day in accordance and
~n conformity with Chapte~ 222, Section 222.17, Florida Statutes.
1 was formerly a legal reside~t of - ~'1.~YYL.CYL,~ - - - -G11---- 4s'-lt, - -
{City) (State)
and I resided at _ 7_Q~ \~p~y~~~~-L~~- - . However 1 have changed my domicjle
(Street and Number) ~
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ro and am and have been a bona fide resident of the State of Florida since l.J day of ~
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~Yti~R~U 19
7.~, and I reside at __1_Q_Q-~--~ i
- - - ,
(Street and Number) ~
FORT PIERtE, SAIN? LUCIE COUNTY, FIORIDA ~
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and this slatement 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 domicile, purchase of home, etc.)
i
20g764
f ILED AMO RECTY FU.
J iT.lUC1E COUTRAS
ROCER PO
CIERK CIRCUIT COURt
RECORO VERIFIEO~
MAtt Z~ 38 ~H'~ ~ •
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I FURTHER CERTIFY that I will oomply with all other requirements of a leyal resident of this State.
~ 1 FURTHER CERTIFY that 1 have no intention to return to my former domic,ile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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Swom to and subscribed before me this day of , 19_L_.
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~ _ ~iRC{NJ.C~f~-, Notary Public
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~ 6y ~ D.C. My Commission expires
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(To'~., i~' • and ori inal fil~d with Cbric Grcuit Court, and dupliut~ with Tax Ass~ssor.) t
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Fto. 13