HomeMy WebLinkAbout1709 225~62 ~ ~
Decla~ation ot ~omicile and Citlze~ship :
TO THE STATE AND COUNTY TAX ASSESSOR,
51. IUCIE COUNTY, FLORIDA:
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This is my dectaration of Oomicile and Citizenship in the State of Flo~ida that I am filing this day in attordante and
~n confo~mity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of _-~Sc1l~_~-~ti ~f=
(City) ate)
and 1 resided at ~ _ __~~[i~- _ _ _ _ _ _ . However I have changed my domicule
(Sireet and Number)
to and am and have been a bona fide resident of the State of Florida since _~~.~-lt~_ ~ day of
. . 19~-~-, and 1 reside at ~~L-~.~-.L~ -
, ~ (Street a~d Number)
FORT PIERCE, SAINT IUCIE COUNTY, RORIDA
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and this statement is to be taken as my declaration of citizenship, actual legat reside~ce and domicile in the State of Florida. '
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(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 RJRTHER CERTIFY that I will oomply with all other requirements of a leyal resident of this State. ~
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~ I FURTHER CERTIFY that 1 have no intention to return to my former domiCile, and I intend to remain in FORT ~
~ PIERCE, SAfNT LUCiE COUNTY, FLORIDA, permanently_ RICHARD ~AYKISH ~
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(Name)
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. Sworn to aAd subs~iibed before me this ~?th day of ~reh ~ ~q 'l2
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~ ~ ~ C1RG~JIY ZOURT Notary Public
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~ By D.C. My ~ommission expires
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(To b~ ex~cvt~d in dupliut~ and ori~inal fil~d with G~rlc Cjnuit CouA, and duplica» with Tax Ass~s~or.)
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