HomeMy WebLinkAbout0399 . ~y
Declaratio~ oY Domicile and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR, n
Sl. IUCIE COUNTY, FIORIDA: ~~~v~ ~
This is my decla~ation of Domicile and Citize~ship in the State of Florida that 1 am filing this day in acco~dance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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I was formerly a legal resident of _~1o~~w L~ ~,C/ ~ q K~ 4~. t
(Ciry) _ (State) ~
and 1 resided at _d~'' 3_?_?__1~~% ~C <~e -'Z~ - _°_AQ~~. Howeve~ I have changed my domirrle
(Street and Numbe~) #
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to and am and have been a bona fide resident of the State of Florida since _ day of
=z'-`-_ - . 19 and I reside at ~ °s~ ~ ST.
~ (Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, adual legal residence and domicile in the State of Florida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
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at former domicile, removal of family to new domicile, pu~chase of home, etc.)
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~ 233103.
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1 FURTHER CERTIFY that 1 will oomply with all other rsquiremenri of a le9al resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiCile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ Swotn to and subscribed before me this day of ~ , 19~ ~
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CLE~1~ "UIT COURT Notary Public
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~ By .C. My Commission expires i
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~ (To b~ ~x~cuhd in duplica?~ and ori~inal fil~d whh Cl~c Grark Cour~, aed dupliu» with Tax Ass~s~or.)
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~ BOGK 2O~ PALf J9~
~ No. 13 A
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