HomeMy WebLinkAbout0316 _ -
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Declaratio~ ot Don~icil• and Citiz~nship ~
TO THE STATE AND COUNTY TAX ASSESSOR, 2d8489
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Sl. IUCIE ~OUNTY, FIORI~A: ;
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This is my declaration of Domicile and ~itisenship in the State of Floride that I am fili~g this day in stoord~nce ar?d ~
~n conformity with Chapter 22?, Sectio~ 222.17, Florids Statutes. ~
I was formerly a legal ~esident of O ~~~'O .
(Ciy) (State) ~
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end 1 resided at v G~ ~'._-~`xF~.___ ~ However 1 have chanqed my domitile
~ and Number)
ro and am end have bcen a bona fide resident of the State of Florids since _ day of 1
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-~~c-~- _ 19?~_, snd I reside et - 1
(Street and Number)
FORT rIERCE, SAINT LUt1E COUNTY, fLORlDA
end this statement is to be taken as my declaration of citizen~nip, actual leflal reside~ce and domicile in the Stste of flo~ida. t
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(Insert here any pe~tinant facts, such as sale of property o~ business, or relinquishment of employment
at former domicile, removal of family to new domicile, purcfiase of home, etc.)
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~ 1 FURTHER CERTIFY that I will comply with all oth~r requir~menri of • leye) resident of this State.
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~ 1 FURTHER CERTIFY that I have no intention to return to my forme~ domiule, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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3 (Address)
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~ Swom to and subscribed beforo me this ~~G dsy of ~ , 19~
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, ROGER~
~ CIL~K ~ ti Notary Public
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8y O.C. My ~ommis:ion ~xpires
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~ Re b~ ix~691~i1'1~'' •nr oriyinal Al~d wltb CIKIc Grcuh Courl, and duplieab wiTh Tax Ass~aer.)
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