HomeMy WebLinkAbout0597 Declaration ot Domicile and Citizenship ~
TO THE STATE AND COUNTY TAX ASSESSOR, ~~14821 j
51. LUCIE COUNTY, FIORIDA:
This is my declaration of Oomicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
in co~tormity with Chapte~ 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of _~~C'%F!~~!'~ IL~C-~ ~E -
_ Kiy) - _ _ (State) !
and I ~esided at _~--!~"d~!'~~_ - . . However 1 have changed my domic.ile .
(Sireet and Number)
to and am and have been a bona fide resident of the State of Florida since _ day of
~ O ~~'AsV /.J~!/c= - - _
~U~ 19~~, and 1 reside at
, f (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.
Nnsert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal af family to new domicile, purchase of home, etc.)
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1 FURTHER CERTIFY that I will comply with al) othe~ requirements of a legal resident of this State.
I fURTHER CERTIFY thai 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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(Name) CL4 ~i?
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• 4 •Sworn to and su~jscribed before me this ~G day of - ~ , 19~
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' ~ ~ ~,~G PS~Ii~?S ~ -
,~''~,GI~UR C RT Notary Public
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By ~ O.C. My ~ommission expires
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(To b~ ~xecut~d in duplicat~ and ori~inal fil~d with CIKk Cinuit Court, and duplicaN with Tax Ass~s~or.)
„ a~x195 ~ 59'1.
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