HomeMy WebLinkAbout0303 S
oecieration ot Domicile and Citise~ship 2~4610
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. WCIE COUNTY, FtORIDA-
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This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and ;
~n conformity with Chapter 222, Section 222.17, Flo~ida Statutes.
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1 was formerly a legal resideM of ~~.LQ !~i__ _ _ _ - . _ - •
~;ty) (Sta e)
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and I resided at ~~D~ /_t~s1 t~'~ - - However 1 have changed my domiti~e
~ (Street and Number)
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to and am and have been a bona fide resident of the State of Florida since [X day of F
t.~.LtLD _ /CdJ ~ ~ ~ i
~ Q.~ , 19_~/ , a~d I ~eside at 3_Z~ _ LC.~~LII. r- a
(Street a~d Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my decla~ation of citi2enship, actual legal residence and domicile in the State of Fforida.
(Inse~r here any pertinent facts, such as sale of property or busi~ess, or relinquishment of employment
at forme~ domicile, removal of family to new domicile, pu~chase of home, etc.)
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. • ~ fIIED lE COUNTY flA.
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R~CO~O v[a~iiEp ~OYIIT
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I FURTHER CERTIFY that 1 will compty with all other requirements of a leyal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my fo~mer domicjle, and I intend to remain in FORT
PIERCE, SAINT IUCIE COUNTY, FIORIDA, permanently.
__!„L~!L~ /L/~L/il
ame)
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~ ~ , (Address)
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~ ~worn tp sAd~l?'su~ttibed before me this ___~~P - day of , 191.1_.
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' ' R04f~ !'OQR+~F -
~ RT Notary Publie
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By _ D.C. My Commission expires
(To b~ sx~aM~d in dupliub ~nd ori~inal fil~d with CIKIc Grcvit Cou~t, and dupliut~ with T~x Ass~ssor.)
_ 1.y5 PAGE 303
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