HomeMy WebLinkAbout0358 a9eclar~tlan ot Oomicii• a~d Citi;enship
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TO THE STATE AND COUNTY TAX ASSESSOR, ~ ~
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Sl _ IUCtE COUNTY, FLORIUA: ~
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Th~s is my ~ieclaration of Oomicile and Citizenship in the State of Florida thst I am filing thia day in actordance and ;
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~n conformity with Chapter 222, Section 2?2.17, Fiorida Statutes. 1
I was formerly a legal resident of : . _ w~tJ.J~+E!~C`Or'~ _ L~!!L
(City) (Stari) ~
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and 1 resided a` ~ ! ~ ~ U~°------- ~ Nowever I have chars9ed my domitile }
(Slreet and Number) ~
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~o and am and have been a bona fide rosident of the State of Florida since -~~E~C.~ day of
~ R~ ~ ~ - - - . 19 ~ and I reside at ~~~~if~e~~D ~e ~ L o ~ ~ ~ o- -
(St~eet and Number)
FORT PIERCE, SAII~lT lUt1E COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, adual leflal ~esidence snd domicile in the State of Florida.
(Insert he~e any pertinent fads, such aa sale of property or b.isiness, or relinquishment of employment .
at former domicile, removal of iamily to new domicile, purthase of home, ett.) - , -
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ilLfe ~?Mp qfC0ADE0
ST. ~~~E COUNTY ftA. s
C!E KCCtRCWT COURT ~ V
RECORD YEP,lFIEO...~,~~
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1 FURTHER CERTIFY that I wil) aomply with al) other requirements of a leyal resident of this State.
1 FURTHER CERTIFY that 1. have no intention to- ~eturn to my former domicjle. and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. •
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!Name)
3'~S :~,F~t~~~~E (~d- L~~~t '`.~o
(Address)
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Sworn to a~d subscr~bed before me this day of S , 19L. ~
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Cp - Notary Public
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~ ~.C_ My ~ommission expiras _
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~~i ..~i'~d(~srlcJ ~a ~p~ut~ and wioie~al Al~d with Cl~lc Greuh Cou~t, and duplieat~ wiN~ Tax Asws~or.) I
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