HomeMy WebLinkAbout0622 Declaration ot Do~nicile a~d Citizenshlp
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TO THE STATE AND COUNTY TAX ASSESSOR, ~
214839 ' ~
Sl. WCIE COUNTY, FLORI~A: `
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This is my declaration of ~omicile and Citizenship in ihe State of Florida that I am filing this day in aaordance and f
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~n rnnformity with Chapte~ 222, Section 222.17, Florida Statutes.
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I was forme~ly a legal resident of __~Ir~~sL - -
- ~~~ty~ (State)
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and 1 resided at ~ ~ Nowever I have changed my domicjle
(St~eet and Number)
to and am and have been a bona fide resident of the State of Florida since ___Lj v~_ / 5- _ day of
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19~1_, and I reside at ~ Z ~ S• 2
- - - ~ (Street and Number)
PORT PIERCE, SAINT LUCIE COUNTY, FLORI~A
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Ho~ida.
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(Insert here any pertinent fads, 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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~t''~~~'` ` FI~EO ANO RECOROEO
ZT. I,UCIE COUMTY f~A.
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ClE KCC RCUIT~C s
~ ~ RECORO VERIFIEO.~..~
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I FURTHER ~ERTIFY that I will oomply with all other ~equirements of a legal resident of this State.
1 FURTHER CERTIFY that I have no intention to return to my former domiti~e, and I intend to remain in FORT
PIERCE, SAINT IUCIE COUNTY, FIORIDA, permanently.
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`~strb~`~ibed before me this / day of , 19
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~ .C~ : Notary Public
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8y ...a ~ 8~ O.C. My Commission expires
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Ro b~ ~x~wt~d in dupliub and oriyinal Hl~d whh Clirk Grcui! Cou~f, and duplicaf~ with Tax A~ssorJ
,a ~ eooK196 ~ 620
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