HomeMy WebLinkAbout1033 DeClaration ot DomiCile and Citizettship 2 0 6 913
10 THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FLORIDA:
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This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and ;
~n conformity with Chapte~ 222, Section 222_17, Florida Statutes.
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I was formerly a legal resident of (~C.Q/~Of~O_(,(/QG!^~~E~ l! ~`~G-L~ _!~~/'J C"~~''~lfY ~
(City) (State) ~
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and I resided at _~li !~3 ~!T~'t'~?~11~C-~!t~____ _ However I have changed my domici~e ~
(Street and Number) ~
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ro artd am and have been a bona fide ~esident of the State of Florida since /7~fiE~CN c~ d_. day of
_ _ . _ , 19~~, and I reside at ~Qa7 _rl~C,~I~L~C~~~ -
(Street and Number)
FORT PIERCE, SAIN? LUCIE COUNTY, PLORIDA ~
and this statement is to be taken as my dectaration of citizenship, actual legal residence and domicile in the State of Florida. i
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(Inserr here any perti~ent facts, such as sale of property or business, or relinquishment of employment ~
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at former domicile, removal of family to new domicile, purchase of home, etc.) ~
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~ I FURTHEit CERTIFY that I will comply with all other requirements of a legal resident of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domiGle, and I infend to remain in FORT
PtERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_ ~
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~ - - - 1 `
x (Name) ~
~ Dr~rid NaCalla F
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Swom to and subscribed before me this day of 19 . :
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~ 1~~~~VRT -Notary Public _
~ BY ~ I D.C. My Commission expires -
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~ (To-;~~riwf~d'ti dupliut~ and oripinal filsd with Cl~rk Circuit Court, and dupliut~ with Tax Ass~ssor.) ~
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