HomeMy WebLinkAbout1238 Declaration ot Domlcile ~nd Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR. ~ 223331
Sl. IUCIE COUNTY, FLORIDA:
This ~s my declarat~on of ~omicile and Citizenship in the State of Florida that I am fil~ng this day in accordance and
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~n conformity with Chapter 22~, Section 222.17, Florida Statutes. ~
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1 was formerly a legal resident of .
(City) (State) ~
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and I resided at _ However 1 have changed my domiCile
' (Sireet and Number) ~
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to and am and have been a bona fide resident of the State of Florida since ~ S T _ day of
~ v~~/ 'r ~ 19~ and I reside at _G ~'~~1 G L~l U f~, ~L ~~U
~ (Street and Number)
FORT PIERCE, SAINT tUC1E 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 ot employment
at former domicile, removal of family to new domicile, purchase of home, etc.) t
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~ I FURTHER CERTIFY that I will comply with all other rcquirementa of a leyal resident of this State. ~
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~ I FURTHER CERTIFY that I have no intention to return to my former domic,ile, and 1 intend to remain in FORT ~
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PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. )
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. Q~-LL.L.~ -t~? !-C_,t.~ ~
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~ Sa~uel J~NamiBpisardi ~
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~ Swom to and subscribed before me this 7~ _ day of ~~~?-~~-4-''-`~ 1~1--
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ROGER POITRAS - i
~ K CIRCUIT .COURT Notary Public ;
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- By ~ D.C. My Commission expires _
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(To be ~xecuted in duplicat~ and ori~inal filed with Cl~rlc Circuit Gourt, and duplicats with Tax Ass~ssor.) F
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