HomeMy WebLinkAbout0486 Declaration ot Domicile a~d Citize~ship
TO THE STATE AND COUNTY TAX ASSESSOR, ~~~~5
Sl. WCIE COUNTY, FIORIDA:
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 2~2, Section 222.17, Floride Stat~tes.
1 was formerly a legal resident of t~~L.c~_____. ,
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~~;ty~ (State)
and I resided at _ !.3 ~~sR~%~-'~-~-' _ . . However I have changed my domiti~e +
, (Street and Numbcr)
to and am and have been a bona fide resident of the State of Florida since L~is U - deY ot
, 19__~~. and 1 reside at _.__!~~.r~_- _B_ 7~,,,,.~~---~ .
(Street and Number)
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FORT PIERCE, SAINT LUCiE COUNTY, FLORIDA ;
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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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G~ . /L~-~~`~ ,2 0
~ FILED AMO RECO N
ST. ~UCIE COUMtY~I~.
CLERK CtRCU1T COyRj
RECORB YERIFIEO,.,.¦.~j~~~
Auc 1~ 4 3s PM'T~
2~14~4~
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1 FURTHER CERTIFY that 1 wil) comply with all other requi~ements of a le~al resident of ihia State.
I FURTHER CERTIFY that I have no intention to return to my former domiGle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ,
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(Na e) DsIR z E,s '
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n'/~n 1
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~ ~ S~ ' l -.t i ~r ~ w CL -~~i . 4
~ (Address)
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' .ti'~irorn.to ~•aubscribed before me this day of -_-_~~.Y~t- . 19~
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~ RoaHe roirRas ~
~ CiRCUtT,COUR~ - Notary Public ;
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6y ~ ~ D.C. My ~ommission expires
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(To b~ ~x~cuted in duplicst~ snd ori~insl fil~d witl~ Cl~rlc Grcuit Court, and dupliut~ with Tsx Ass~ssor.)
~i9~ ~ 486
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