HomeMy WebLinkAbout0190 Declaration o! Domicite and Citizenship
~35104
TO THE STATE AND COUNTY lAX ASSESSOR,
Sl. lUC1E COUNTY, FIORIDA:
This is my declaration of Oomicile a~d Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Flo~ida Statutes.
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1 was forme~ly a legal resident of _ _ _ _ e A . R. ~ _ _ _
' (Ciry) (State)
and 1 ~esided at ~
3
~ ~._T. ~y~ • ~ • ~2 _ _ _ Howeve~ 1 have changed my domici~e
(Street and Number)
to and am and have been a bona fide ~eside~t of the State of Florida since o~ day of
19_l
Zand I reside at _~?LL~~ J'`~'~~DO~C ~/~N~
~ (St~eet and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal ~esidence and domicile in the State of Florida.
(Insert here any perrinent 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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~35104
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CIERR c?~:CU t COURt
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I FURTHER CERTIFY that 1 will comply with all other requirements of a legal 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. WILI,IAD` . GENT
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(Name)
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~ ' f d~a~~' ~ur~bed before me this ~b - day of ~ , 197 Z-
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-~(i~~GtE~K• COURT Notary Public
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By ~ _ D.C. My Commission expires _
(To be oxecuted in duplicate and o~igi~al filed with Clerk Circuit Cnurf, and duplicate wilh Tax Assessor.)
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