HomeMy WebLinkAbout0838 Deciaration of Domicite and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, 235569
S i. LUCIE COUNTY, FLORIDA:
This is my declaration of Oomicile and Citizenship in the State of Florida that 1 am filing this day in acco~dance and
~n conformity wilh Chapter 222, Section 222.17, Florida Statutes.
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i was formerly a legal resident of _ w 1•a y-9~--_
(Ciy) (State)
and 1 ~esided at # y ~a'X. ~ 3 ~ However 1 have changed my domiCile
~ (Street and Number)
to and am and have been a bona fide ~esident of the State of Florida since _ _ day ot
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19~~ and I reside at ~__=7 D y r~ ~Y~.-- !_L_1'~' _
(Street and Numbe,r~
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA t
~
and this statement is to be taken as my declaration of citizenship, actual legal residence a~d domicile in the State of Florida. j
(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.) _
~~LED ~ttD Rfd~iCl~ ~
lE C4UIf?'~ ~
~tOCER PO~~'~?s
~ C~ERK CIRCUIT ~
11ECORD ~ER~FtE~
. ~ 1~ I~i ~1 ~ ~H'~Z '
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,
235559
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1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of ih'ss State.
I FURTHER CERTIFY that I have no intention to return to my former domiG~e, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
y ~4'~
(Name)
Da/~ Qe~'S
~ RaS ~ maMT R P~s
~ •
~ (Address)
'.Svi~orn~tQ at3d'syburibed before me this day of ' , 19~L
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• .
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, ~ ROCsFJi~ O R~tS
• ;~LERI{~~~R~~ COU Notary Public
. ~ .
By ' D.C. My Commission expires
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(To be executed in duplicate snd original filed with Clerk Circuit Court, and duplicate with Tax Assessor.)
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