HomeMy WebLinkAbout2745 ~ ~
Declaratio~ ot DomiCile a~d Citlze~ship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FLORIDA: ~~0~1
This is my declaretion of ~omicile and Citi=enship in the State of Florida that 1~m filinq this day +n aoo~rdancA a~d
~n oonformity with Chapter 222, Section 222.17, Florid~ Statutes.
1 was forme~ly a fegal ~esident of -S H TAt? •e _122# ~ -
tCity) (State)
and 1 resided at ~~_?.1 ~ n TS~_ Rn ~t d . However I have chan9ad my domic~~e
(Streat and Number)
ro and sm and heve been a bona fide resident of the State of Florida sinoe S i rTN day of
- DEC f/`113E.N , 19~.L, and I ~eside at S'r~.~v t~....be l~ r~ or~ L
(St~eet and Number)
so. F~o~ rRt Nwr• !
FORT PIERCE, SAINT lUC1E COUN~Y, RORIDA
end this :tatement is to be taken as my detlaration of citizenship, aciual legal residente a~. :~.:.^nicile in the Stste of Florid~.
(Insert he~e any peninent facts, such as sale of propefty or busineu, or ~elinquishment of employmer~t
st former domicile, removal of family to new domicife, purchase of home, etc.)
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~ 1 RJRTHER CERTIFY that I will oomply with al) other roguirements of a lopal resident of this State.
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~ 1 FURTHER CERTIFY that I have n~ intention to ~etum to my former domic~~e, and I intend to rema+n in F~RY
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permsr~ently.
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~ - ~ T~s~..
~ (Name)
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- 'Yn~ F
` (Address)
' SwoFn :to ~ns~ si~bstr~bed before me this day of 19 •
i.;= . `
~t
- ~ ROC~~A`
~AS Notary Public
Ct#RK V
gy . D.C. My Commission expires
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(Tq ~~s~q~ol~Nl in d~pliwt~ and oripinsl filed witi~ CIKk Grarit Ca+et, and ~rplieat~ witi~ Tax /1ss~swra
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ao~197 ~~2741
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