HomeMy WebLinkAbout1681 [3~claration of ~7omicife and Citizenship
~1'7609
THE STAIE AtiD COUNTY TAX ASSCJSOR, •
~l. LUCIE COUNTY, FlOn1DA:
Th~s ~s my dec;arat~on of ~o~7~~ciie and C~t~zer.sh~p in the 5;ate of Flo~ioa that i am f~ling th~s day in accordance and j
.n conformity w~th Chapter 222, Sect~on 222.17, Florida Statutes. ~
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1 was formeriy a lega! residentof ---l~°~~_~~~~ _ t
(City) (Sfate) `
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~eoti~~~p 5T ~ ~
<,nd 1 resided at _ - - - - - _ - _ _ - _ However 1 have changed my domiGile
(Street and Number)
'o and am and have been a bona fide res+dent of the State of Florida since ______~_Sc2___ day of
~ - 19~ ~ , and 1 reside at __1 J ~~~L ~ ~ ~
(Street and Number)
FOR7 PIERCE, SAINT ~UCIE COUNTY, FLORtDA
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; and this statement is to be taken as my declaration of citizenship, actual legal rzsidence anci domicii~ in the State of Florida.
_ (Insert here any pertinent facts, such as sa(e of property or business, or relinquishment of employment
at former dorniciie, removal of family to new domicile, purchase of home, etc.) •
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1 FURTHcR CER7IFY that I will comply w;tn all other requirements of a legal resident of ihis State.
1 FURTHER CERTIFY that I have no intent~on to return to my'former domitile, and { intend to remain in FORt
~iERCE, SAINT LUCIE COU~ITY, FLORIDA, permanenily. ~r',jC~~A~L POV ~
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Swprn tp ancl~;~{~i3cr~bed before me this day of ~4=~-~''~~~- , 19~.
~.,,:~;~~i;t~ - -
~ ROGER P017RA5
: IERK GIRCUIT COURT b~~K 196 FAGE ~~VO Notary Pubiic
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, ~y D.C. My Commission expires
(To be vxowtcd in duplicate and original filed with Clo~ic Gircuit Court, ~nd duplicato with Tax Assossor.)
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