HomeMy WebLinkAbout2999 _ Oeclaration ot Dorr~tcile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR.
Sl lUC1E COUNTY, FlOR10A
fhis ~s my decla?alion of Dornicile and C~tizenship i~ the State of Florida that 1 am filing this day in accordance and
~n conform~ty with Chapter ??2. Sect~on 2??.17, Florida Statutes.
1 was formerly a legal resident of . 1(~ 4( !tJ d ~ Nq _C _
(City) (State)
and 1 resided at ~~l~ ~~~~1 However 1 have changed my domiCG~e
(Street and Number)
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~o and am and have been a bona fide resident of the State of Florida since _ day of ~
~4 we , 19.~/ , and I reside at ~y_.~. .~~____~T• 1 ! ~1'~ce
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
ind this statement ~s to be taken as my decla~ation of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pert;nent facts, such as sale ot property or bus~~ess, or •elinquishment of employment
at former domiule, removal of family to new domicile, purchase of home, etc.)
' S u S s~.~ 7~ h• ~ s ` ~
j~ N G r c e~v ~,yo accoa~EO !
FIIE~ ?C COUN1'~ ~A• i
St• ROGEz• PO~~AAS
rYl ~ ~~t G're .c- N ~dGU1t COURt
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1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I ~
~ I FURTHER CERTIFY that I have no intention to return to my fcrmer domicjle, and 1 intend to remain in FORT
~ ~~ERCE, SAINT Lt1C1E COUNTY, FLORIOA, permanently.
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} ~ct c. L (Name, .r < < r? t
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~ (Address)
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a Sworn to ar.d subscr~bed before me this 3__ _ day of ________C_~t.~- c-u~L- 19~~
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~ . - - ~~oo~ • ~?s - - - - - - - ;
~ _ CLERK C1RCU COURT Notary Public
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By ~ D.C. My Commission expires _ _ ~
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(T` b~, in dupliut~ and oripinal til~d witb CI~?Ic Grcuit Court, and dupliut~ with Tax Ass~ssor.)
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