HomeMy WebLinkAbout0052 .
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FIORIDA: • ~~~~0~ ~
This is my decla~ation of Domicile and Citizenship in the State of Florida that I am filiny this day in accordance a~d
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in co~formity with Chapter 222, Section 222.17, Florida Statutes. . '
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I was formerly a legal resident of '
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and I resided at ~11~L2- ' However I have changed my domitile
(Street and Number) -
to a~d am a~d have been a bona fide resident of the State of Florida since '~~il'.i ~,t,.I day of
_ . 19--, and 1 reside at Q~~~ ~~.T.~ •
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declarotion of citizenship, actual legal residence and domicile in the State of Flerida.
(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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~ 1 FURTHER ~HtTIFY that I will comply with al) other requlrements of a le~al resident of this State.
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~ 1 fURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
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~ PIERCE, sAir~T.ti~. GAuNnr, FLORIDA, permanently. ~
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- Sworn to and subscribed before me this ~ dey of , 1~?'
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~ ROGER lORRAS
CIRCUIT COURT Notary Public
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~ By D.C. My ~ommission expires ~ "
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~ tTo b~ ~acuird in duplicah aod oriyin~l fil~d wili~ C~ek Cirwh Coue~, a~d d~pliuM with Tax A~sior.)
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