HomeMy WebLinkAbout0997 Oeclaration of Domicile a~d Gitizenship
;~13046
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FLORIOA:
This is my declarat~on of Dom~ule and Citizensh~p i~ the State of Florida that 1 am fiGng this day ~n accordance a~d '
~n conformity with Chapter 222. Section 22?.17, F!orida Statutes. ;
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1 was forme~ly a legal resident of - -
~C;~y~ (State)
~nd I resided at ~aj(~~~ _ However I have changtd my domiCile
(Street and Number)
ro and am and have been a bona fide reside~t of the State of florida since .GC U day of
, i9_~~, and ! reside at /_~Q. f - ~
(Street and Nu r)
FORT PIERCE, SAINY LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citiz~nship, actual legal residence and domicile in the State of Florida.
(Insert he~e any pertinent facts, such as sale of property os business, or re~inquishm~nt of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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I FURTHER CERTIFY that I will comply with all other requirements of a legal reside~t of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicrle, and I intend to remain in FOR7
~ P!ERCE, SI~INT LUGE CUUNTY, FLORIDA, permanently. T~
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~ (Name)
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~ ( ddress)
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~ Swom to ar~d wbsC~ibed before me this _ day of _ . _ _ 19~~ _
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Ra~~,-~!ott~?s• . - - - _
'~RCUIt C Notary Public
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gy _ _ _ _ D.C. My Commission expires _ -
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(To b~ ~xsluNd ~[n dupliut~ snd ori~inal fil~d with Cl~rk Circuit Cou?t, snd dupliuts ~rith T~x Ass~ssor.)
~ :,`~?194 997
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