HomeMy WebLinkAbout1311 Declaratio~ ot Domicile and Citisenshlp
TO THE STATE AND COUNTY TAX ASSESSOR, 2~49z
51. LUCIE COUNTY, FLORIDA:
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This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Floride Stetutes.
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I was formerly a legal resident of __~~t~~~_~___-~__ _~~N~
(Ciy) (State)
and I resided at _ t ~ _ _ _ ~C1 _ _ _ _ _ _ . Howeve~ 1 have thanged my domicjle
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _.~C~C. _L~ Z~ day of
-_~-C-T ---L~, 19~~ and I reside at _/~H.~_~U/~L~ h ~ N.~2~ l>~ _ - _ ~
(Street and Number) !
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FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Flo~ida.
(Insert here any pertinent facts, s~ch 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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~IERK CIi;C~tf~Q~ t(~~ f
RECORD YERtFIEp~ ~ D ~
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` I FURTHER CERTIFY that I will comply with all other requirements of a leqa) resident of this State. °
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e I FURTHER CERTIFY that I have no intention to return to my former domiGle, and I intend to remain in FORT ?
~ PIERCE, SAINT LUClE COUNTY, FLORIDA, permanently. ~
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~ (Name) L~N~y
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- - (Address)
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Sworn tts' and subscribed before me this day of C~- , 19
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CLfRK CIRCUIT COURT Notary Public
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BY ' D.C. My tommission expires
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= (To bs sx~cvtsd in dupliut~ and ori~inal ~iled with CIKk Grcuit Court, and duplic~h with Tax Ass~.)
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