HomeMy WebLinkAbout2242 Declaration of Domicile and Citizenship
24'~~~'
TO THE TATE;.~ND COUNTY TAX ASSESSOR,
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_ ` ~u~~~-_ COUNTY, FLORIDA:
Zl~is is my declaration of Domicile and Citizenship in the State of Florida that I am Cling this day in
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accordance, and in conCorniity with Seetion 222.17, Ftorida Statutes. }
i was formerly a Icg~l resident of C~~9~P~CLs-G c~-~ 2¢~ '
. and I t
G ,,.Q~ ~ (C1tY) (State)
resided at _ d l n~ . G'`~' . However, I have char.ged my domicile to ~
(Street and Nu r) ~
~~d am and have been a bona fide msident of the State of Florida since ~ day ot'
~ ~j _ . 19~ and I reside at ~-Z Q ~ • ~e.l 1~~~` ~
, ~ . ^ (Street and Number)
-'~'~'~G~ , -~-L~G County. Florida,
(citr)
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 pertinrnt facts, such as sale of p~operly or business, or relinquishment of employmeet at forme~
domicile, removal ot family to new domicile, purchase of home, etc.)
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'l~eii~LG~=~,~`'` • ~C.L
24~~'~
fftEO ANO RECOROEp
St. LUCIE COUMTY F~A.
CLERxCCR Ct1iT COURT
REC4Rt3 VcRIfIED
~ ~ ~ 38 ~'73
1 FURTHER CERTIFY that t will register at my locai address when the rcgistration books rcopen, and
comply with all other requirements of a legai rrsident of this State.
I FURTHER CERTIFY that 1 have no intention to return to my former domicile, and I intend to remain in
/ ~~~l~%~C-Ci - ~-L(.~.c~ ' ~
County,
Florida, ger~itanently_ «"r~ t .
. M!.
.1~.\\~I~i~~~1,1J: /~.,i~ .
r ~ - -
`~.r~ - (N te)
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_ C ~ ` _
. ' . C. ~ ' ' (Addressl - -
f ~tir' :l : ' - q
~'.Sworti'te•arni1~'UDscribed before me this ~1ay of
n~ . • ~
. r '
G~~
- A.D. 19~3
a~i
Notary Public State of ~lorida at LarRe ~
My Commission expires _ ~S' ~y~` "
(To be exrcuted in dupiirale and onRinal tilyd with Clerk C'vcuit Court, and duplicate Nith Taa Assessor)
aooK 21~ ~~ct 2r.~,• ~
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