HomeMy WebLinkAbout1466 Declaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Si . LUCIE COUNTY, FIORIDA: q O~J 1(1 ~
~ 1 17
This is my deciaration of Dom~cile and Citizensh~p in the State of Florida that I am fili~g this day in accordance and ~
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~n conformily with Chapter 222, Section 222.17, Florida Statutes. ~
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1 was formerly a legal resident of .re:-f~Gc'~_ r,?~~-~___
(City) (State)
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and I resideci at ~
r-~~„~re~ zCli However 1 have changed my domiGle
(Street and Number)
ro and am and have been a bona fide resident of the State of Florida since -T-~/./. 4 _ _ _ day of
_ , 19_~! , and I reside at _ _ 1 c~ L ~ ~ _ _ .
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, ftORIDA 3
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and this statement is to be taken as my declaration of citizenship, actua{ 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.) •
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FI~EO AMO RECOR~~
:T.l1iC1E C011NTY ~
ROCE!i P01TRAs ~a„J
CIERI~ CIRCIIIT COIMT~~
IIECORO YERIFIED.~~.~~
Ar~ 8 10 ~ ~M't I ~
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~ I FURTHER CERTIFY that I will comply witfi all other requirements of a(egal resident of this State.
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I FURTHER CERTIFY that I have no intention to return to my former domic,ile, and I intend to remain in FORT
~ PiERCE, SAINT LUGE COUNTY, FLORIDA, permanently. ~
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a 's
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~ (Name) ~
~ _._.L . I,t.,` ~Illq m S
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(Address) '
- Swom to and subscribed before me this day ot _ , 19~L_.
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- ~s.~' ~ ~'~v ~ ~CQURT Notary Public
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By~ : , _ D.C. My Commission expires
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r ~~~6t~_,in dupliute a~d ori~inal filsd with Clerk Circuit Court, snd duplicat~ with Tax Ass~ssor.)
~ ~~a ~ 3 ao~K 191 1464
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