HomeMy WebLinkAbout0949 ~ ~
Declaration ot Domicile and Citisenship
TO THE-STATE AND COUNTY TAX ASSESSOR, 223138 i
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Sl. IUCIE COUNTY, FLORIDA: ;
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This is my declaration of Oamicile and Citizenship in the Slaie of Fiorida that i sm f~ling th~s ~ay in accordance and
~n conformity with Chapter 222, Settion 222.17, Florida Statutes. ~
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I was formerly a legal resident of ~~(~C~ ~ _ . .~~1(14 . . _ _ a%_ !t?____ _ _ y
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and 1 resided at ~~V b~N ~~~!<<?_ ^_`_1_~-``_-~~'~ _ However 1 have changed my domic,ile
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(Street and Number) ~
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to and am and have been a bona fide resident of the State of Florida since _ day of ~3
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- - U~ _ _ , 19~!_ , and I reside at - l ~1~ - --~Y ~
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, HORIDA
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
at former domicile, removal of family to new domicile, purchase of home, etc.)
B~ T7` ~~7Z E'~J' ;
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fT~L C E COUNTY F~A:
ROC~~ FOiTRAS
CLERK C ;GUIT COURT
RfC(?R^ vf=•rtED ~x
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FEe I 4 s2 PM '1Z
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; 2~138
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~ 1 FURTHER CERTIFY that I will mmply with all other requirements of a lega) resident of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domic,ile, and I+ntend to remain in FORT
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanentiy.
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(Ad~ress)
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; . Sworn to ! ~++d wb~rit~ad before me this ~ 3~ _ da of - ~l'L_~'!? , 14 ! ? . -
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R~~ T Notary Puk~G.. - y
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f By - c^ ` D.C. My Commission expires i
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" (To bs ~x~cut~e! in dupliut~ and oripinal ~ilsd with Cl~rlc GrcuH Court, and du~iicate with Tax Assessor.) :
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