HomeMy WebLinkAbout0071 Decia~atio~ ot Domicile and Cltize~sh~p
214434
TO THE STATE AND COUNTY TAX ASSESSOR, . •
Sl. LUCIE COUNTY, FLORIDA: ~
This is my declaration of Oomicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
~n conformify with Chapter 222, Section 22~.17, Flo~ida Statutes. `
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. 1 was formerly a legal resident of _ - -
~ ~~~ty ~ (State)
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However 1 have changed my domicjle ~
and 1 resided at - _ - - -
(Street and Number)
to and am_ and have been a bona fide resident of the State of Florida since - _ _ ~
5 day of
;
s- - :
_ - 19_~/ and 1 reside at ' -
- _ . _ -
(Street and Number
1
FORT PIERCE, SAINT LUCIE COUNTY, fLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent fads, such as sale of property or business, or re{inquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.) .
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f 1.Eo ~Ne RECOROEo
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~p°ro~T~s u' t~
CIERK C1RC~IT COtNtt , ,
R[COAD YERtFIEO
Aua 1~ I a8 PM'71
' 214434
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I FURTHER CERTIFY that I will oomply with ell other requirements of a legal resident of this State.
1RTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, ~FLORIDA, permanently.
i!~~I~ _-~~l~
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~vZ_ (Name) D~~~ ~t~//F/e
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Sinom te an~l''~scr~tied before me this ~ day of _ C~ ~ , 19
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b~~ _ ,~.,~,f~a~~"~'~~y" '
. - ~~Kif3•'r0~'[RAS - -
QI~UIT COURT Notary Public
~~r.~ /
gy D.C. My Commission expires
(To b~ ~x~cvhd in dupliut~ and oripinsl ~il~d with ClNic Grcuit Court, and dupliut~ with Tax Ass~swr.)
~ a~~~~i~5 P~~ 71
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