HomeMy WebLinkAbout0712 Declarati~n ot Domicile and Cltlzensitip
~1285'7
TO THE STATE ANQ COUNTY TAX ASSESSOR,
Sl lUCIE COUNTY, FIORIDA:
This ~s my declaration of Domicile and Cit~zensh~p ~n the State of fto~ida that 1 am filing this day in accordance and
~n conformity with Chapter 222, Section 2?2.17, Florida Statutes.
1 was formerly a legal resident of ~.P. --<-e~~ _
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and I resided at w ~C>-~~l~.~-~' - _~'d!%~-~ Nowever I have cha~ged my domiGi~e :
(Street and Numbe?) ~
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ro and am and have been a bona fide resident of the State of Ftorida since ~~1~`P~JL~ --.Z.t~i~ - day of ~
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~?L.Ei , 19._ ~l, and 1 reside at / l'--~3c2t -k ~[2. ~ ' - ~
(Street and Numbe~) ~
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 Stafe of Florida_
(Inse~t here any pert~nent 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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21285'7
flLE~ ~EC~ROEO ,
~i. WC1E COUN Y fU• ;
itOGER PO~TA~S
CIERK CIR~~~T ~WRT ~ .
IIECORO YER~f1E0r.•~~~ ~
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~ 1 FURTHER CERTIFY that I~will comply with all other requirements of a legal res':dent of ihis State.
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I FUftTHER CERTIFY that I have no intention to return to my former domic,ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently_
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~ _ 9wott~,to ar~d~t~j1p~bed before me this _ ~ ~ _ day of _--~c_~ - - 19 ~ l ;
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'ri~ CIR~',UJ
~~'COURT Notary Publit
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ay ~ ~ ~ ~'S- ~('f - U.C. My C~mmission exp~res -
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(To b~ ~xecutsd in duplicat~ snd ori~inal fil~d with Cl~rk Grcuit Cou~t, and dupliute with Tax Asse~sor.)
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