HomeMy WebLinkAbout1478 ;
Oeclaratio~ ot ~omicile and Citisenship ;
~ 225624 ;
TO THE STATE AND COUNTY TAX ASSESSOR. • '
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51. LUCIE COUNTY, FIORIDA: k
This is my declaration of Domicile a~d Citizenship in the State of Florida that 1 am filir?g this day in accordance and
~n confo~mity with Chapter 222, Section 222.17, Florida Statutes.
I was formerty a iegal resident of - CS S /•7~ S 5 •
~C~ty~ (State)
and 1 resided at Cd Goi?i~G L.~n/~ ~Wever 1 have changed my domitile
(Sireet and Number)
Tn
ro and am and have been a bona fide resident of the State of Florida since day of
_11/o~IrM,~3E~ 19~~ , and I reside at ~IOO ~ t. -.~oG i~N ,l7.~/ r/E'~
(Street and Number) i
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FORT PIERCE, SAINT tUC1E COUNTY, RORIDA
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 pertine~t facts, such as sale of prope?y or business, or ~elinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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CLERKCC RCUIT q~RT cq~
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! RJRTHER CERTIFY that 1 will oomply with all other requiremenb of a le~al resident of this State.
1 FURTHER CERTIFY that I have no intention to retum to my former domiCile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. _
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(Name)
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~ 2 6 r• ejo G.l~~7 ~/E
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~ :-1~~i~~ap~ subscribed before me this ~ day of ,
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~ Ro .b~ ~acul~d in dvpliuN and ori~inal fil~d wili~ CMrk Cirarit Co~N, and dupl~cat~ with Tax Aa~ssor.)
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