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Deciaration of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
~~'402
Sl. IUCIE COUNTY, FtORIUA: ~
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This is my declaration of Oomicile and Citizenship in the State of Florida that 1 am filing this day in accordance and ~
~n conformity with Chapter 222, Settion 222.17, Flo~ida Statutes.
I was formerly a legal resident of . . . ~11~!_-- - _ _ . _ - . _ _ _ _ _ - - i
(Ciry) (State)
and 1 resided at _ V~~~ ~ !~'~`1 _ However t have changed my domicjle
(Street and Number)
~a and am and have been a bona fide resident of the State of Florida since _~'~1 ~ J/_ _ day of
_ - - - - 19__7~ and 1 reside at ~_7~ ~
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(Street 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.
(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, pu~chase of home, etc.) ~
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~ I FURTHER CERTIFY that I will comply witfi 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 domiCile, and I intend to remain in FORT
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~ PIERCE, SAINT lUC1E COUNTY, FLORIDA, permanently. JOSLPH E. VI ~
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~ ~~~~~t~r,,, ~ , ~ (Name)
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_ _ ; • t~'_ (Address)
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~ ~ `{a/and,syh~cribed before me this ~ day of , 19.~..
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a ~I/ ~M~~~~~~ • . I
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- ~ KClGlR "Pr~ITRAS ;
GIERK CIRCUR COURT Notary Public
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~y ~ D.C. My Commission expires
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s (To b~ ~x~cut~d in dupliut~ and original filad with Cbrk Grcuit Cour1, and dupliut~ with Tax Ass~ssor.)
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~ ° ~ 191 ~72~3 ~
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