HomeMy WebLinkAbout0417 ~
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Declaration ot Oomicile and Cltisenship
TO THE STATE AND COUNTY TAX ASSESSOR, z14~Op
Sl. IUCIE COUNTY, FLORIDA:
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This is my detlaration of Uomicile and Citizenship in the State of Florida that I am filing this day in accordance and ~
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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I was formerly a legal ~esident of _ _ _ _ - -
(City) (State)
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and I resided at ~ ~ > _ . - However I have changed my domicjle
(St~eet and Number)
fo and am and have been a bona fide resident of the State of Florida since 1~l day of
- _ , 19~! , and 1 reside at l~/Q- -~~i[~Q~J~I ~ ' - - - -
(Street and Number)
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 facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.) ;
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I FURTHER CERTIFY that I will mmply with all other requirements of a leqal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicrle, and 1 intend to remain in FORT 'r
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ , ~ • J : ~/O 2G~Q~tG~ /~C~-~i=G</r/ _ .
~ _ r:.:; (Address)
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~ ,•~rorn to.ap~`'ri6stribed before me this _ day of - , 19~
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. ..y ...C4~~:~ -
Roi~ae ~ romws
~ CLERK CIRCUIT COURT Notary Public
~ By _ O.C. My Commission expires
(To b~ ~xecut~d in dupliut~ and oriqinal ~iled with Cl~rk Circuit Court, and dupliut~ with Tsx Ass~s~or.) ~
~ 6~~~ is5 417
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