HomeMy WebLinkAbout1143 Declaration ot Domicile and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~
21933U
Sl. LUCIE COUNTY, FIORIDA:
This is my decla~ation of Dom~ciie and Citizenship in the State of Flurida that 1 am Filing this day in accordance and
~n cc~nformity with Chapter 222, Section 22~.17, Florida Statutes.
I was formerly a legal resident of _~4?-LT~1~_~%~-G1~___-__--.
(City) (State)
and I resided at ~
e~~~t~- However 1 have changed my domiv~~
(Street and Number)
ro and am and have been a bona fide ~esident of the Stab of Florida since dsy of
--~vY__~---__-- 19~'~, and I resicie at ~.~_L~a-~ N-~~V Y-~~YP _
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this sratement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert he~e any pertinent facts, such as sale of property or business, or ~elinquishment of employment
at fo~mer domicile, removal of family to new domicile, purchase of home, etc.)
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~ 1 FURTHER ~ERTIFY that 1 will oomply with all other rsquirements of a leyal resident of this Stste.
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~ I FURTHER CERTIFY that I have no intention to retum to my former domiCile, and 1 intend to remain in FORT
~
PIERCE, SAINT LUCIE COUNTY, FLORIOA, permanently.
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~ (Name) S ~ h e I~ n'
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_ ~ f~w 3~1~suburibed before me this r'` day of Z , 19~.
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P~AS /
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_ ; ~ '~~OfY COURT Notary Public
_ y ~jC ~ GO `~~~~r
" 8y ~ ~ D.C. My Commission expires
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~~y ~ (To b~ execut~d ie dupliut~ and ori~inal ~iled wiih Gtrlc Grwit Court, and dupliut~ with Tax Assossor.)
= aooK197 ~~~E1142