HomeMy WebLinkAbout1371 Deciaration ot Domicile a~d Citisenship
TO TNE STATE AND COUNTY TAX ASSESSOR, 0 711 e7
i lUC1E COUNTY, FIORIDA
This ~s niy declarat~on ot Uo~»~ule and Cit~zenship in the State of Flor~da tha? I am t~~ing this day in accordance and
n conformity w~th Chapte? 222, Secnon ?22.17. Florida Statutes
1 was fo~meriy a Ieyal resident of ~/~~~~~PQI~ l~~~
(City) (State)
,nd I ~es~ded at a~c'~Jr /T~'~GfLV~t?d However I havechanged mydomiCile
(Street and Number)
7
~o and am and have been a bona fide resident of the State of Florida since ~ day of
Pn~l~Q/~ . 19 ~O, and I reside at l~7 ~~~2M7Qt~ ~~°i~-~----
(Street and Number)
FORT PIERCE, SAiNT LUCIE COUNTY, FLORIDA
jnd this statement ~s to be taken as my declaration of citizenship, actual legal residence and ~omic+le in the State of Florida.
(Inse~t 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.)
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~ I FURTHER CERTIFY that I will comply with all oiher requirements of a legal resideni of this State.
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~ I FURTHER CERTIFY that I have no inte~tion to return to my former domic,i{e, and I intend to remain in fORT
~ ?iERCE, SAWT LUCIE COUNTY, FLORIDA, permanently.
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; ~ ,•;~•g:,:;~~ U~:p~ Bruce S. ~N'~ec~rndiYe
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_ Swoiri to~'di?d'~Subscribed before me th~s - _ Y _ _ - 19~- -
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ROGER POITRAS
CIERK CIRCUIT COURT Notary Publ~c
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~ dy ~ _ D.C. My Commiss~on expires
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(To be executed in duplicste and original filed with Cl~rk Circuit Court, and duplicate with Tax Assessor.)
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