HomeMy WebLinkAbout0361 Declaration of ~ ~rnicile and Citizen~hip
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TO THE STATE AND COUNTY TAX ASSESSOR, ~ 2~229
Sl. WCIE COUNTY, FIORIDA:
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, Section 222.17, Florida Statutes.
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1 was formerly a legal resident of _~_~_~~C_:~, _-~1! '
(City) (State)
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and I resided at However I have changed my domiCile
(Street and Number)
to and am and have been a bona fide resid~TtiT'of the State of Florida since ~s~_1~_ °l~. __~.'2._____.____ day of
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19~.~, and 1 reside at _ ~
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(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA -
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, removal of family to new domicile, purchase of home, etc.)
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fILEO ANQ ~ECORDED
St.lUC1E tiOUMiY f~~•
ROCE R ?01«~S C
' CLERK C`.~C!!?t COURT
I REC~R^ YE ~ EO
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1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that 1 have no intention to return to my fo~m~r domi~ile, and I intend to remain in FORT
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PIERCE, SAINT LUCIE COUNTY, FLORlDA, permanently.
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~ Sworn tq and subscribed before me this day of . , 19~~
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YRk Notary Public
~ gy D.C. My Commission expi~es
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A:Y i;t)1?Iiril~Si E~tPfK~S itiB. l~yr 11~
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~ (To be executed in duplicate and originsl filed with Clerk Circuit Court, and duplicate with Tax Assessor.)
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