HomeMy WebLinkAbout0153 Declar~tio~ ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, 2~46~0
Sl. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Flo~ida that I 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 c~7CY~ CL _ G~C%•C6l~?-t2~~~?
(City) - - (State)
and 1 resided at _ S~~! G' ~''~L/`~ v~CL~/`~R However I have changed my domi~ile 3
(Street and Number) ~
to and am and have been a bona fide ~esident of the State of Florida since . - day of
_ - - _ _ , 19~1, and I reside at S - ~-t-'u 2 -
• ( eet and Number)
FORT PIERCE, SAINT LllCIE COUNTV, FtORIDA
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.) '
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I FURTHER CERTIFY that I will mmply with all other requirements of a legal resident of this State.
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I FURTHER CERTIFY that I have no intention to return to my former domiCile, and I infend to remain in FORT
~ PIERCE, SAINT IUCIE COUNTY, FLORIDA, permanently.
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, (Address)
Sworn to,and s~bscribed before me this day of - , 19~L
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- ROGER ~S. -
CLERK CI~ ~fOURT Notary Public
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By ,~J ~~.''<uti - O.C. My Commission expires
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(To b~ executed in duplicat~ and ori~inal fii~d with Cl~rk Grcuit Court, and dupliute with Tsx As~ssor.)
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° R ~ z00 F~~~ ~53
No 13 A b~V~.
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