HomeMy WebLinkAbout0524 Deciaration ot Dorr~i~lle and Citisenship
2:33190
TO THE STATE AND C4UNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FIORIUA:
This is my declaration of Oomicile and Citizenship in the State of Florida that 1 am filing this day in accordance and +
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerl a I al resident of _ ~ b~ _ - !
Y e9
(State)
lQ19 I ~t ~~q
and I resided at (~-_-~?_L ~ t (V w- However I have changed my domitile
(Street and Number) ~
to and am and have been a bona fide resident of the State of Florida since ~ _ day of
Ne~~ce~ ~sC'~oC ~o. ~3ox ii~ 6
~
- . 19 and 1 reside at oo s
~ (Street and Nu 33 f, S 7
~ ~ T
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA ~
and this statement is to be taken as my declaration of citizenship, actual legal residence a~d domicile in the State of Florida.
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(Insert here any pertinent facts, such as sale of p~operty or business, or relinquishment of employment ~
at former domicile, removal of family to new domicile, purchase of home, etc.)
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RECORD YERIFIE~.~....,~~.
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233190
I RIRTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to retum to my former domicj~e, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. } „ )
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~•°ti~±JG;, (Name)
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~~'SwArn!tq~bnd subscribed before me this ~°2 day of , 19~~ ~
. .
ROGER PDITR/15
GRCUR COURT Notary Public
By D.C. My Commission expires
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(To bs ~x~cuhd in duplicats ar~d ori~insl fi'led with CIKIc Cira~it Court, and duplicat~ with Tax Assessor.) 3
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No. 13 p ~
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