HomeMy WebLinkAbout0924 Declaration ot Domicile and Citizenship
10 THE STATE AND COUNTY TAX ASSESSOR, ~1~'i~~ry^
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51. LUCIE COUNTY, FLORIDA
Th~s ~s n?y declarahon ot Donucife and Cit~zenship ~n the Sta+e of Flonda that I am f~l~ng th~s day ~n accordance and
n cor,formi~y w~th Chapter ?22, Sect~on 222.17. Flor~da Statutes
I was formerly a tegal res~dent of ~ 1~~~L~/V-S~~K ~ v
(C~ty) (State)
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,r~d i resided at J ~S (~=G ~ ~r~ Nowever I have changed my domic,ile
(Street and Number) ?
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~o and am and have been a bona f~de resident of the State of Florida since ~ day ot
CC r~ 6 ~ ~ , 19 ~T ~ , and I reside at 'Z/ ~ ~E~5~1~~'
~ (Street and Number) ~
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA ~°R r~~ ~ v v l~ i
and this staiement is to be taken as my declaraticn ot citizenship, actuat legal res~dence and domicile in the State of Florida.
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~ (Insert here any pertinent facts, such as sale of property or business, or rei~nquishment of employmem
~ at former domici~e, removal of famiiy to new domicile, purchase of home, etc.) _
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ST LUC~E COUNtY fl~.
AOG~~ ?O~TR,tS ~N~J !
~ CLEF.K C:nCU1T COURT ~
RECOr,~ ~~r~~,~iEO
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_ I FURTHER CERTIFY that I will comply with all other requirements of a legal resideni of this Ssate.
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f FURTHER CERTIFY that I have no iniention to return to R1y former domi~e, an~l inlend 1o rem~n in FORT
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~ VIERCE, SAiNT LU..IE COUNTY, FLORiDA, permanently ~,1,~ ~~-h.~,
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_ (Name)
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: :_;.Swqra and,subscnbed before me th~s ' `
~ . . 2° ~ f ? - day of _ ~ _ - , 19 7~ .
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- . ~ • ~O~TRAS
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~ C1~CUR COURT Notary Publ~c
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: By - _ D.C My Commission expires
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_ (To be executed in duplicate and original filed with Clerk Circuit Court, and duplicat• with Tax Assessor.)
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