HomeMy WebLinkAbout0846 Oeclaration ot Domicile and Citizenship
TO TNE STATE AND COUNIY TAX ASSESSOR, . ~355~4
Sl. IUCIE COUNTY, FLORIDA:
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This is my declaralion of Domicite bnd Citizenship in the State of Florida that 1 am tili~g this day in accordance and ~
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~n con(ormity with Chapte~ 222, Section 222.17, Florida Statutes.
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I was formerly a legal resident of 1~~ /F~~1~A~~Q ____-~I •
(City) (State)
and 1 resided at !2. 7~_~~1C~I_~_S ^ R n~~ Nowever 1 have changed my domi~ile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since . day of
v~ V'S 19
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a; and 1 reside at J ~ 3 J~•
(Street and Number)
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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 facls, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicite, purchase of home, etc.)
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTNER CERTIFY that 1 have no intention !o return to my former domiu~e, and I intend to remain in FORT
PItRCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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(Name) h~ ~ ~ ~
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Sworn to~~o~s~bscribed before me this day of~ -r/1~/ , 19~Z~
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~ ROGEK~ POIt'#tA5
CLERK ;~{~CUIT COURT Notary Public
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- By D.C. My Commission expires t
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(To be executed in duplicate and original filed with Clerk Circuit Court, and duplicate with Tax Assessor.) ~
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