HomeMy WebLinkAbout0026 Decla~ation ot Dornicile and Citizensl~ip ~)~.~()3
TO TNE STATE ANO CC3JNTY TAX cSSOR.
51 WUE CUt1PlTY, FtORIDA
Th~s ~s my declarat+on of Qo~~~~c~le and Cit~zensh~p in the State of Florida that 1 am fil~ng th~s day in accordance and
~n conforr~~~ty wilh Chapter ?22, Sect~en 222.17. Flo~ida Statutss ~
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1 was formerly a legal residern of L~ „ L' , 4~~
(C~ (State)
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and ! resided at ~~a ~_L~s'~=lG ~C However I have changed my domic,ile
(Street and Nurnber)
!o ar~d am and have been a bona fide resident of the State of Florida since G~•: Lt- day ot
'1 .
~t,L . 19 _ and I reside at .~~~-3 ~~?"1'LC.~'~~~'`~ .
(Street and Number)
FORT PIERCE, SAINT LUCiE COUNTY, FLORIDA
and :h~s statement es to be raken as my dectaration of citizenship, actual legal residence and dom~cile in the State of Florida.
(Insert here any pe~t~ner.s facts, such as sale of property or bus~ness, or relinquishment of employment i
at fnrmer domicile, removal of family to new dor:~ic~le, pur:hase of home, etc.)
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ESTABLISHING RESII`ENCE
f LE~ ~KD REC011DE~
i~. LUCIE C~iUNTY Ft .
QOCER PO~TAAS
vENTERING CHII,DREN IN SCHOOI, RECORO VER F EO C~.~.._ '
A?~PI,YING FOR H0~6ESTEAD ~ A~M~
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1 FURTH~R CERTiFY that I will comply with all other requ~rements of a legal resident of this State.
I FURTFtER CERTIFY that I have no intentEon tvi ceturn to my former domic,ile, and I intend to remain in FORT
PiERCE, SAINT LUCIE CO;INTY, FLORIDA, pe~manently.
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~ Sworn t~ ~arrd subscritsed l:eiore me this - _ _ aay of 19 -
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~ ROCER FOtTR/?S - - - - - - -
~ SIFRK CIBCUIT COURT Notary Public ~
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~ ~ _ _ _ _ D.C. My Comm;ssion expires ~
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~S (To b~ execuf~d in duplic~h and oripinal fil~d with Cbrlc Circvi: Court, •nd dupiiut~ with Tax Assfssw.) :
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