HomeMy WebLinkAbout1146 Declaration ot Domicite and Citizenship
TO THE STAIE AND COUNTY TAX ASSESSOR, ~~.,r~Q~
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51. LUCIE COUNTY, FIORIDA:
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This is my declara~ion of Domicile and Citizenship in the State of Flo~ida that I am filing this day in accordance and {
in conformity ~vith Chapter 222, Section 222.i7, Flo~ida Statutes.
I was fo~merly a legal resident of __~~Af~a_~~~__ _1 y~ W d/C~, ,
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(City) (State) ;
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and I resided at ~~r ~'EA~ _ 1~•E - However I have changed my domi~ile
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(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _ day of !
---~1L- 19~~ and I ~eside at 1~~J_~_l~•eA~?f1 d L) S7'.
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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. ;
(Inserl here any pertinent facts, 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(egal resident of this State.
1 FURTHER CERTIFY that I have no intention to return to my former domi~ile, and 1 intend to remain in FORT
PIERCE, SAINT LUCtE COUNTY, FLORIDA, permanently_ JAMES 1~'. YAN
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~C? Cp 's'i, (Name)
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'yi~~~i,~rr~t0~~d~subscribed before me this day of ~ , 19~.
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ROGER POITRAS
CLERK C CUIT COURT Notary Public
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d;~ - D.C. My Commission expires -
(To be executed in dupiicate and origina! fiied with Clerk Circuit Court, and dupliwte with Tax Assessor.)
~ BOOK~S PACE1~.46
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