HomeMy WebLinkAbout2064 ~eclaratlon ot Dort~icile a~d Citizenship 213'7"71
TO THE STATE AND COUNTY TAX ASSESSOR, .
Sl. LUCIE COUNTY, FIORIDA:
ihis ~s niy declarahon of Dom~cile an~ Gtizensh~p in the Stare of Florida :hat I am f~i~ng this day in accordance and
~n conformity with Chapter ?22, Section ?22.17, Florida Statutes.
I was formerly a legal resident of ~i~~~
~
(City) (State)
and 1 res:c~~ .r ~o~..~ 1~ .'"i~ _ }
However 1 have changed my domic.i'a ~
(Street and Numberj !
'o and am anc! have been a bona fide resident of the State of Florida since G~~^~ D _ day of
, 19_~~ , and I reside as ~~~-~~-~t~~~_~!~
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA ~
and th~s sfatement is to be taken as my declaration of citizenship, actuat 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 E
;
at former domicile, rernoval of famil to new domicile, ~
y purchase of home, etc.)
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~ ' r~LEO ,,wo ~~coROE~ ;
gt.LUC~E COUMTV fl~ +
iIOCER r 0~ ~RAS ~ ,
~~ERK ~F^F EO C~Rt
REtORO YE •
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PN 1
Auc 12 2:~9
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I FURTHER CERTIFY that I will cornply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that 1 have no intention to return to my forme~ domic,ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
_ ``~rC~¢t~-~-
(Name) I,oraine Kall
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~ (Address? t'~c~~
~
a
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~ Sworn to and subscribed before me this 2th _ day of ALigLiSt ~9 71 :
~ . '
. :
~ ROGER !~O[TMS . . : ~ - -
CLERK CIBCUIT COI~RY,~~", Notarv Public s
~ ~ _ ~
~ 8Y . - D.C. My Commission expires ~
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~ (To be ~X~NR~in.~apHca~e and original filsd with Cl~rlt Circuit Court, and dupliut~ with Tax Ass~ssw.)
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