HomeMy WebLinkAbout0837 Declaration ot Domicile and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA: , ~~'~-~iiqC
a~
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
~n confo~mity with Chapte~ 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of ~1 -
(City3 tate)
and I resided at _ However 1 have changed my domitile
~
(St eet and Number)
ro and am a~d have been a bona fide resident of the S1ate of Florida since J~/~~f day of
~
_ _ . , 19--- , and I reside at ~GJ_ ' !~i"~~l
(Street and Num
FORT PIERCE, SAINT LUCIE COUNTY, FLOit:~~
and this statement is to be taken as my declaration of citizenship, actuaf lega) residence and domicile in the St~te of Florida.
(Insert here any pertinent facts, such as sale of propery or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
~ ~ J~///~) f
~ 2E ~ 1.-~ ~t.,?~It t» J~ s a/C c~-~~~
~
~ :
FIlEO ANU ~ECOa~E~
iT, IUCIE COUN~ ~L~'
aoc~R ~o~tM= ~
ItEC0R0 VERtF4E0..•+Tf
E ~ 18 3 25 PM'~ ~
~
~
;
~ 219095
F
5
~
~
k
g
~
~
~
~ I FURTHER CERTIFY that I will comply with all other requirements of a(eyal resident of this State.
~
~ I FURTHER CERTIFY that 1 have no intention to return to my former domiCile, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIUA, permane~Hy. . !
~ ~
~ - ;
~ -
(Name) ~?~E N 1
k;
~
_ ~ ~ -
(Address)
SYVOtn. to and suburibed before me this ____~C~__- day of --_,~L"l~!QY*~ - , 19-L~
.
_ . R06iR PORlA~;: - - -
' CIRNt~ ~O{~RT Notary Public
- ~
By ~ D.C. My Commiss~on expires
~'i . . ~ ~ ^
~ ~;'1
- (To b~ ~x~c~ i~ dwpliut~ snd ori~inal Rl~d with C{Kk Gnuit Cour1, and dvpliut~ with Tax Ass~sfor.)
~ ~ o~K ~.97 F~~f 836
!;o i 3 -