HomeMy WebLinkAbout2132 y~ .
~ Declaration ot Domjcite and Cit~zenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~
S1. IUCIE COUNTY, FLORIDA: ~~1?~J
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This is my declaration of Domiciie and Citizenship in the State of Florida that 1 am filing this day in accordante and
~n conformiy with Chapter 222, Section Z22.17, Florida Statutes. ;
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I was formerly a legal reside~t of ~
~~;ty~ (State)
and 1 resided at _~04 _ R~ ~ e~' O r~ d t~ However 1 have changed my domiti~e
(Street and Number)
to and am and have been a bona•fide resident of the State of Florida since s a PT ~ g ~ 91 ~ dsy of
. 19~~, and 1 reside at ~ y Q d /V - 4~2 n•~ J~
. (Street and Number)
t
FORT PIERCE, SAINT LUCIE COUNTY, FLORIGA
and this statement is to be taken as my declaration of citizenship, adual legal residence and domicile in the State of Florida. ;
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(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employme~t
at former domicile, removal of family to new domicile, purchase of home, etc.) ~
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St. A POItRI?~ 1,~
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VERIF~EO
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
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I FURTHER CERTIFY that 1 have no intention to return to my former domic,ile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
(Name)
2G..~W, L. ~jrc~telQ.,
; nc.~.z
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~ ~ ~ . (Adciress) v~c~/ /`~L
Svirorr~ to-antl ~Esu~ibed before me this day of . 19~-
~ . ~
. QQGEi~ t~QITRAS
LERK CI UIT COURT Notary Public
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~y O.C. My Commission expires
(?o be executed in duplicate snd origi~tal filed with Cle~k G~cuit Court, and duplicats with ?ax Assessor.j
~~Ki~S ~~~130
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