HomeMy WebLinkAbout1601 Oeclaration ot Don~icile and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR, 22155~ j
5~ . IUCIE COUNTY, FIORIDA:
This is my declarat~on of ~om~cile and Citizensh~p in the Staie of Florida that 1 am filing this day in accordance and
~n conformity with Chapter ?22. Section 222.17, Florida Statutes.
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I was formerly a legal resident of N- L~ s~-
.>S .~C 6~t J(' L f~ C/~ ~(Ciry) (State)
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a nd 1 resided at a~~V" 4Sc~~' v b - However I have changed my domicjle
(5 reet and Number)
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ro and am and have been a bona fide resident of the State of Florida since 'C 7- - - day of
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/ ~ C L ~ ~ C n , 19_7~ , and I reside at ~7- 'S~L ~ ~ ~ ~~s / '
(Street an 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 Florida. ;
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment 1
at former domicile, removal of family to new domicife, purchase of home, etc.)
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I FURTHER CERTIFY that I will comply with all other requiremenfs of a legal resident of this State. ~
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~ I FURTHER CERTIFY that I have no intention to return to my former domitile, and I intend to remain in FORT
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permane~tly.
1 ,~:.~u:.~ri t:
~ : ~ifi~l -C'~:~ ~iZl ~ d/(i'~Y~
_ ~v' ~.~j'~~~~,•.'G~.a,% r - (Name)
rz '~~;:~%~G ~r4~4s,yG TQN/~~
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Swiorn'fo~and subscribed before me this s day of ~ . _ . 19~?!
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- on~~Q pe~~TQec
CLERK CIRCUIT COURT Notary Public
gy _ ~~L't.s~ D.C. My Commission expires
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(To be executed in duplicate and origi~sl filed witF~ Cl~rk Circuit Court, snd du~liute with Tax Assessor.)
=~~i a~198 P~1599 ~
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