HomeMy WebLinkAbout1427 DeClaration ot Domicfle and Citisenship :
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~07161 ~
~O THE STATE AND COUNTY TAX ASSESSOR,
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Sl. IUCiE COUNTY, FLORIDA
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This is my declaration of Uom~c~le and Citizenship in the State of Florida that ! am f~ling this day in accordance and ~
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~n conformity with Chapter 222, Section 222.17, Fforida Statutes. ;
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I was formerly a legal resident of ..c t~ ~ • . _ _ ~ ~ L _ ;
(City) ~ " (State) ~
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and I resided at ~y'Q~ ~~~,%CCl~. ~~~'~l_r Nowever 1 have changed my domicile
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ro and am and have been a bona fide resident of the State of Florida since ~L'~i
~ J~ j/~~/_ day of ,
, 19_ , and I reside at ~~~7 Q_~ ~ ~
(Str t and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Ir~sert here any pertinent facts, such as sale of property or business, or relinquishment of emptoyment
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at former domicile, removal of family to new domicile, purchase of home, etc_) ~
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~ 207161 ;
~ 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 I have na intention to relum to my former domi~ile, and I intend to remain in FORT ~
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA~, permanently. j
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~ (Name) Pstrioia L. Ailsua ~
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(AddressY ~
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~ Swprn to and subscribed before me this day of _ 19~_. .
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- ROGER,.~`WT~S,.;~ ~ ~
~ R~I~~V~~ , Notary Public
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~y D.C. My Commission expires _ _
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(To b~ ~i~~+~ luplid/R a~d originsl filsd with Cl~rk Grcuit Couvt, and dupliut~ with Tax Assessor.)
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