HomeMy WebLinkAbout1473 s
Declaration ot Domlcile and Citizenship ~
TO THE STATE AND COUNTY TAX ASSESSOR, ~`~SV
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Sl. LUCIE COUNTY, FLORIDA:
This is my declaratio~ of Domicile and Citizenship in the State of Florida that I am fi~ing this day in accordance and
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~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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1 was formerly a legal resident of - -----~~G:/l.(.~J _
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~C~ty~ (State)
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and I resided at ~ . However I have changed my domiCile +
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~ (Street and Number)
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to and am and have been a bana fide resident of the State of Florida s:;.~~ ~ 7 day of
_ _ - 19~~_, and I reside at ~~4 7__ Q-''`~ . _ _ _
(Sireet and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Flo~ida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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; FILED 4NG itECORDEO '
~ ST. LUCIC COUNTY FLA.
` ROCtn ~'OtTRAS
~ CLERK C:H~UIT COURT
; RFCG`~D YfRiFl~p~~~ ~
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~AM ~ 13 ~'7Z ~
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~ 1 FURTHER CERTIFY that I will comply with all other requirements of a le9al resident of this State.
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~ I FURTHER CERTIFY that I have no intention to retum to my former domiGle, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanenily.
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~ (Name) ~
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Sworn to and subscribed before me this ~ day of , 19~°Z
ROGER P017RA5
' GIRCUIT COURT Notary Public
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f=`~ By ~k'~~~'v D.C_ My Commission expires
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(To b~ executsd in duplicaN and ori~insl filed with C{nlc Grcuif Court, and duplicats with Tax Assestor.)
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aooK~~O PAGE1471 ~
No. 13 A
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