HomeMy WebLinkAbout0422 ti i
Declaration ot Domicile and Citise~ship
TO THE STATE AN~ COUNTY TAX ASSESSOR, •~8842
Sl. lUC1E COUNTY, FLORIDA:
This ~s my declaration of Donuule and Citizenship in the State of Florida that I am filing this day in accordance and
:n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was forme~ly a legal resident of (~G~~ - ~~~--lZ~trt~~G~
(City) (State)
and 1 resided at~ Ti~ a~~~w~1~ ~l.~41_~-_ . _ However I have changed my domiCi~e '
(Street and Numbe~) ~
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ro and am and have been a bo~a fide resident of the State of Florida since _ day of
~/1~~~.~L L a2 . 19~~ , and I reside at ~loZ G - - - - -
(Street and Number)
FORT RIERCE, SAINT LUCIE COUNTY, fIORlDA
and this statement ~s to be taken as my declara~ion of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicife, removal of family to new domicile, purchase of home, etc.)
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~ F1LE0 Ak0 REC~RQ~~
iT.IUClE COUM T f~
ROCER POITRAs ~
CLERK CiRC111T C~
AECORO YERtf1E~~ ~
~ 15 12~ ~M'~I
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I FURTHER CERTIFY that I wil) comply with all other requirements of a leya) resident of this State.
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I FURTHER CERTIFY that 1 have no inte~tion to retum to my former domiti~e, and I intend to remain in FORT
~ PtERCE, SAINT LUCIE COUNTY, FLORIDA, Qerrnanently.
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~ (Name) : , - ~ - f ~ ~ r .
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' Swom to and suburibed before me this _ ~ y _ _ f ~ - ~ r' 19,~ }
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' ROGER P017RAt ? •
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CIERK CIRCtlff COURT ._y° . Notary Public
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BY - - ` - D.C. My Commission expires -
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(To b~ ~x~cul~d i~ ~cats and originsl fil~d with Ct~rk Circuit Cou~r, and dupliut~ with T~x As~ssw.)
„ _ . do~~ 197 ~~t 422
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