HomeMy WebLinkAbout0333 . ;
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Dacla~at~on of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR. 233pss j
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Sl. IUCIE COUNTY, FLORIDA: ~
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This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Settion 222.17, Florida Statutes.
1 was forme~ly a legal resident of __~51~~~S4~'v ~E
(City) (State)
and 1 resided at ~a~ j~_ ~ U However I have changed my domiCile i
(Sfreet and Number) ;
i
to and am and have been a bona fide resident of the State of Florida since ~_._7_~~~-__ ~ day of
, 19~.~! and I reside at ~v f ~A L~ ~ ~ U~ _
(Street and Number)
FORT ~IERCE, SAINT LUCIE COUNTY, RORIOA
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, ~emoval of family to new domicile, purchase of home, etc.)
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' 233056
I FURTHER CERTIFY that I will oomply with al) other requirements of a legal resident of this State. ,
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I FURTHER CERTIFY that 1 have no intention to ~eturn to my former domi~ile, and I intend to remain in FORT i
:
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PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. - ~
(Name) B j R N dQu I?~
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(Address)
: Swora .fo.'an~ subscribed before me this day of , 19~
7
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. CLE~I( CIRCUif COU Notary Public
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By O.C. My Commission expires
(To be ~x~euhd in duplicah and ori~insl Aled with Cl~rk Gnvit Court, snd duplicats with Tax As~ssor.)
No. 1J A. ~ ~
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