HomeMy WebLinkAbout0698 Deciara4ion oi Domicile and Citizenship ~
TO ThE STATE AND COV~~:TY TAX ASSESSOR, '
Sl, IUC.IE COUNTY, FIORlDA: 216J~O
Th~s ~s my decla~at~on of Dom~cile and Cit~Zenship in the Stafe of Florida that I em filinfl this day in eccord~nce •nd
~n conform~ty with Chapter 222, Section 222.17, Florida Statutes. ~
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{ was formerfy a iegal resident of ~ , S~~ ! ~ ~
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~~;ry} (State) E
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and 1 res~ded at ~T~~_,~nCS ~ However I have chanqed my domicjle' ~
(Street and Number) `
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to and am and have oeen a bona fide resident of the State of Florida since day of
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~ - ~ , 19~L, and I reside at ~~C ~ ~ / `7 G r / RC `E' - f
(Streat and Number) ~
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FORT PIERCE, SAINT LUCIE COUN7Y, FLORIDA
and this stasement is to be taken as my dec{aration of citizenship, actual legal residence and domitile in the Stata of Florida. ~
; (Insert here any pertinent facts, such as sale of property or business, or relinquishme~t of employment
; at former domicile, removal of family to new domicile, purchase of home, etc.)
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= I FUR7HER CERTIFY ihat 1 wi~l comply with ail other requirements of a leflal residant of this Stste.
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~ I Fl;R7HER CERTIFY that I have no intention to return to my former domiule, and I intend to remain in FORT
~ PiERCE, SAiNT LUCIE COvNTY, FLOR{DA, permanently.
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_ ~ (Name) Carol L. Speea
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_ ' . ~ • ~ ~ J, ~ (Address) ~
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} Sworn`to and..i~Scribed beforo me th~s day of ~~``~2 ` 19
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= = ROGEit POlTRAS
CIERK CIRCUIY COURY Notary Public
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8y ~ D.C. My ~ommission expires
(Yo b• oxecuted i~ duplicata and or'sQinsl filod with Clork Grcuit Court, •nd duplicat• with ?ax Asa~asof.)
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