HomeMy WebLinkAbout1355 ID~.:.laration of Domicile and Citizensh~p
~ O 7HE STATE AND COUNTY 1"AX ASSESSOR, ~ 21'74Q4
Si. LUCIE COUNTY, FLORi~A:
This +s my dec~aration of Dorn~cile and Citizenship in the State of Florida that I am filing this day in accordance and
~n conformity with ~:hapter 222, Secrion 222.17, Florida Statutes.
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i was formerly a iega! resident of -~1-~-~ v~~-------- -
~C~ry~ (State) ~
~
:
l~ ~ ~ _ Howeve~ I have changed my domi~ile `
and 1 tesided at
(5 reet and Numbe~) ~
T~ - _ day of ~
?u anci am and have been a bona fide resident of the State of Florida since -~T-
s ~ ~ ,
U ~ ~ 19~~ . and I reside at
(S eet and Numbe?)
F~2T PIERCE, SAiNT LUCIE COUNTY, FLORIDA s
and this statement is to be taken as my declaration of citizenship, actual legai residence anci domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employme~t
at former domicile, removal of famiiy to new domici(e, purchase of home, etcJ '
' FILEO AMD itE p~
lUC1E CO~TiI ~
° AOC£R P01 ~ v
- 8~f~tK CI~CW~~Af C~
RECARO Yf Rli1~0~.~i
- O~i i8 !0 aa ~'11
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zl'740~ .
- { FURTHER CERT{Fl( that 1 wi{{ comply witfi all other reqvirements of a legal resident of this State.
. 1
1 FURTHER CER7IFY that I have no intention to retum to my 'former domicile, and 1 intend to remain in FORT !
Pl:RCE, SAINT LUGE COUNTY, FIORIDA, permaner~tly. ~
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~ (Name) . ~
(Address)
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= Sworn to and subscrii~ed before me this ~ day of ~r t'b n , 19, r~
_ ' ~
_ _ . r
= ROGER P01~RA9
GLERK ClRCt111' 7COURT I~:otary Pubiic
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L.r - p,C. My Commission exp~res
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(To b~ ri7te~cuttd in duplicate and original filed with Cierk Grcuit Court~ an:: uu1..~ato with Tax /ltsvssor.?
eoax 19fi PA~E ~355
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