HomeMy WebLinkAbout0401 Declaration ot Don~icile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~~MZ~O4
Sl. LUCIE COUNTY, FIORI~A:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes. •
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I was formerly a legal resident of ~Q ~C'~- ~!v~~ v~~~~ l~ ~ ~''r K
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and 1 resided at ~~CSS_ ~-f1v,C~! oN d Nowever I have changed my domiu~e
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(Street and Number) ~ r, ~h
fo and am and have been a bona fide resident of the State of Florida since . . day of
Jt /'Tt l~/,t~t_iC- - 19~, and I reside at N(~ orts~ < /7~'t nic.i
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~ (Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, adual legal residence and domicile in the State of Florida.
(Insert he~e any pertinent fads, 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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R1LEA 4k0 RECflRDEO
ST. lUC1E COUMTY F~A.
R4CER ?OiTRAS
CIERK C~R~UIT COU ~
RECGp~ V~ n:r,~0
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~ 222804
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~ I FURTHER CERTIFY that I will comply with afl other requirements of a legal resident of this State.
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~ 1 FURTHER CERTIFY that I have no intention to return to my former domitile, and I intend io remain in FORT
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
; ~ONNIE K. CLINE
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~ t~~~~,~~.~.,,...,,~ (Name)
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` ' • ~~d~i'subscribed before me this ~ day of _ ~'~~~`''`'n'~+"~- , 19_2_~
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_ POITRAS - -
IRCUIT COURT • Notary Public
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By ~ O.C. My Commission expires
v~ (To b~ ~x~cuted in duplicate and original ~il~d with Cl~ric Grwit Court, a~d duplisat~ with Tax Ass~ssor.)
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