HomeMy WebLinkAbout1856 Decl~ration ot ~omicile and Citisenship
2095~'8
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FlOR1~A:
' This is my declaration of Domicile and Cit~zenship in the State of Florida that I am filing this day in accordance and
~n conformity w~th Chapter 222, Sectio~ 222.17, Florida Statutes.
I was formerly a Iegal resident of 1~-- r -
( ity) (Sta )
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and I resided at ~ 1~ However I have changed my domiCile
(Street and Number) T,
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ro and am and have been a bona fide resident of the State of Florida since _ _ day of
C~~u. . 19_7 ~ , and I reside at ,L _ y b~ -O ~J ~ •
~ (Street and Number)
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FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA -
and th~s 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, purchase of home, etc.) ~
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I FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domitile, and I intend to remain in FORT
PIEi2CE, SAINT LUCIE COUNTY, FLORIDA, pe~manently.
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~ L (Name)~ R ~P M
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~ Swom to and subscribed before me this day of , 19~.
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~ Sy K u `v D.C. My Commiss~on expires E
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(Tir.~~ ~ a~d ori~inal ~il~d with CI~?k Grcvit Cour~, and ~upliuh with Tax Ass~ssor.)
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