HomeMy WebLinkAbout1073 DeClaration ot Domicile and Citizenship 2 p 6 9 3 8
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FIORiDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
~n conformity with Chapter ?22, Section 222.17, Florida Stetutes.
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1 was formerly a legal ~esident of _ _ ` ~K~T~~-~~ . _ ( ~_3v4 S ~ _ _ ~f _ ~
(City) (State)
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and 1 resided at C.~f~`~!7~ ~~`_l ?C. However I have changed my domiCile ~
(Street and Number)
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ro and am a~d have been a bona fide resident of the State of Florida since ~~'-~T~'3~2 7_._'__ _ day of
_ _ , 19 • , and I reside at a_~~v ~ .i
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(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA T S ~,,C i`~
and this statement is to be taken as my declaration of citizenship, act~al legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of emptoyment
at former domicile, removal of family to new domicile, purchase of home, etc.)
.T~ (I~'6'_5Ll Sl'fcf`~ K~cSI nCNC'c
206938
FIIEG AMO RECORp
:T~ 1~10CERCPO
TaAi~~
CtERR CIRCUIt COINIT ~
' R[CORD YERIFIEO
An~ t 9 22 AN'TI
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~ i FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
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~ I FURTHER CERTIFY that 1 have no intention to retum to my former domicjle, and I iMend to remain in FORT
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~ PIERCE, SAINT IUCIE COUNTY, FLORIDA, permanently. ~z~ ~ ~.2 t'k STi(~p•~ G
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~ (Name) ~o p~ ;
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Sworn to and subscribed before me this day of _ , 19~ f
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~ ROCf~ ~,?.61T~71Sr~{~~`':. - - ~
? ~ ~111~:C0, Notary Public `
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y By D.C. My Commission expires _ ~
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(T°'~ A•d~t~ and oripjnal fil~d with GKk Grcuit Court, and dupllut~ with T~x Ass~s~o?.) ~
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