HomeMy WebLinkAbout2214 Declaration ot Domicite and Citizenshjp
TO THE STATE AND COUNTY TAX ASSESSOR, ~
51. LUCIE COUNTY, FIORiDA: ~~~5
his is my dectaration of Domicile and Citize~ship in the State of Florida that I am filing this day in actordance and
~n conformiy with Chapter 222, Section 222.17, Florida Statutes. ~
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1 was forme~ly a legal resident of _~k~~~-
(Cify) (State)
and 1 ~esided at _ _ . However 1 have changed my domitile
(Street and Number)
to and am and have bee~ a bona fide resident of the State of Florida since '3 dayvof
- - , 19.~_, and I reside at 2 Z- ` ~-C Ai ,
(Street and Number) ~ y ~
PORT PIERCE, SAIN? LUCIE COUNTY, RORIDA ~ ~ '
~
and this statement is to be taken as my declaration of citizenship, adual legal residence and domicile in the State of Florida. ~I
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(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment I=
at former domicile, removal of family to new domicile, purchase of home, etc.)
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ROCER POI7RA '
CLERK CIACUIt C011Rt j:
RECORQ VERtF1E0
_ ~ ~ ZI l2 26 PN'1 t
2158'~'5
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1 FURTHER CERTIFY that 1 will comply with all other requi~ements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicjle, and 1 intend to remain in FORT
PI_RCE, SAINT LUGE COUNTY, FLORIDA, pe~manently. E
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(Name) ff7 l15~t N f %
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~ ~ l /tiy1G-~d ~
(Address) `
Sworn to and suburibed before me th~: day of , 19!_L.
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-;t . COURT Notary Public
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8y _ D.C. My ~ommission expires
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o- ~i~~d in dupliu» a~d ori~i~tal filed with G~rk Grcuit Court, and duplicate with Tax Ass~ssora
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iooK
No- 11 A
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