HomeMy WebLinkAbout1091 Declaration ot DomiCile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR. ~~~AO~
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51. LUCIE COUNTY, FLORIDA:
This is my declaration of Oomicile and Citizenship in the State of Florida that I am filing this day in accordance and
~n confo~mi~y with Chapter 222, Section 222.17, Florida Statutes.
I was formerl a I al resident of a'~-- -
Y e9 -
- (Ciry) - • (State)
and 1 resided at _~1~~ C~!~--- However I have changed my domicile ~
(Street and Number) ~
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ro and am and have been a bona fide resident of the State of Florida since - day of ~
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L~E~T_ - _~.f
~ ~ 7 . ~0---- L.C~s~
19_~y a~d I reside at
(Street and Number) ~n
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA //Cl
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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 relinquishme~t of employrrsent
at former domiciie, removal of family to new domicile, purchase of home, etc.)
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I FURTHER CERTIFY that 1 will comply with all other requirements of a fegal resident of this State. ~
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I FURTHER CERTIFY that I have no intention to return to my former domiule, and 1 intend to remain in FORT ~
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PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. - ~
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(Name) ~
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~ . i 4 5vy~~~ to~aci~'s~lsgi6~ before me this day of U~-_- , 19~
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_ ~'C1~1(, ~IR~I~T O~j T Notary Public
gy ~ D.C My Commission expires
(icate with Tax Assessor.
(To be executed in duplicate and onginal filed w~th Clerk C~rcuM Court, and dup )
EceK~~ P~~~F1U91
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