HomeMy WebLinkAbout2827 Declaratio~ ot Domi~il• and Citfzenship '
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FIQRIDA: '
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and ~
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~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal ~esident of _~~_L~• '
(CiH) ($ta
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and I resided at _~SS~n Qu4__-~ • _ However 1 have changed my domicile
(Street and Number) '
to and am and have been a bona fide resident of the State of Florida since -~S_~--_---_--- day ot
<•s~.t , ac~c
- - 14?! and I reside at ~ ~l1~ d . 7~ ~d
(Street and Numbe~)
FORT ~IERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citize~ship, adual 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.)
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RECOR~E~,
f ~~jE COUw'~ F
ilOGE4 POt~R~s ~
C~ERK ~1;tC1111 CO~~t
aEG~aOyE~;f{EC ~~~Z
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2~458
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~ I FURTHER CHtTIFY that 1 will oomply with all other nquirements of a Isyal resident of this State.
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~ I FURTHER CERTIFY that 1 have no intention to return to my former domiGule, and 1 intend to remain in FORT
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ ~ S~.~l--s--s- t..-~
~ (Name)
~ - .Tose 6. ~Do~:~v~..e~ t
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' ~ . ~ ' ~ . (Address) }
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` ..Saoin tio a~id .subscribed before me this ~ s~ day of _ , 19~
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- Roo~e romu?s
=4 q~ERK ~lRCUIT COURT Notary Public
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By C~~'~-~`- ~`'r ~.C. My Commission expires
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: (Te b~ rx~cutwd i~ dupiiuh and ori~inal H{~d with Ct~ Cireuif CouA, and duplicat~ wilh Tax Ax~wx.)
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~ ~ 3~ 80 ;r 177 ~'..vE L
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