HomeMy WebLinkAbout1347 ~ ~
DeClaratio~ ot Domlcile and Citisenship
TO TNE STATE AND CnUNTY ~AX ASSESSOR, ~~~~R S
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Sl. lUC1E COUNiY, FIORIDA.
This ~s my detlarahon of ~on~iule and Cihzenship in the State of Flo?ida that 1 am fil~ng th~s day in accordance and
~n conformity with Chapter ??2. Sect~on ?2?.17. Florida Statutes.
i was formerly a legal res~dent of l , _ ~~~!r~'7~Q!
(City) (State)
and I resided at .~08 ~/~'nL(~/_, ~7`~- However 1 have changed my domiCi~e
~ (Street and Number)
to and am and have been a bo~a fide resident of the State of Florida since . day of
_
, 19_~/, and I reside at ~/~E~~C~/Q/ . ~
!lerQ- _ .
(Street and Number)
~~f ~'o ~ ~ o ~
FORT PIERCE, SAINT lliC1E COUNTY, FLORIDA ~
-~a-c.~ .~Gt~GL - /'r
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State cf Florida.
(Insert here any ~ertinent facts, such as sale of property or bus+ness, or relinquis~?ment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
L~~~~c C~H G
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P1lFQ ,~1r0 R
sr. tuc~F cou~ir ~o
c~t-RR~cE~ ~~~~s ~
RECpR~ yERrF,Ep Ca~t ~
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22 AM Tt
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I FURTHER CERTIFY that I will comply with all other requirem~nts ~ legal resident of this State. ~
I FURTHER CERTIFY that I have no intention to return to my forn.er domicile, and 1 intend to remain in FORT
~IERCE, SAINT LUCIE CC2'.:l+lTY, FiORlDA, permanently S~~.,, 1~ i L'-'s /~p~ S j~ /
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Sw~n~ tfl and subscnbed before me this _ _ day of . ~ ~ _ _ _ _ , 19~1 ;
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~ RO~R: POfTR/45 _ - _ _ _
~ CtE1~-~IRCUIT COURT Notary Public -
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~Y " ~i'~~^ - -C My Commission expires - - . - - - -
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~ (To b~ •x~cut~d in dupiicat~ •nd oripinal fil~d with CI~?k Circuif Court, and dupliut~ with Tax Ass~asor.) 2
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