HomeMy WebLinkAbout0350 -
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~e~l~rat3on ~t Domicil~ ant~ Citlz~nsh~p -~-~1_~~~+`_.~c~3 i
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TO THE STATE AND COUNTY tAX ASSESSOR,
S1. LUCIE COUNTY, FIORiDA: ~
Tl~is is my de~laration of Demicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
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,n conformity with Chapier 222, Section 222.17., Florida Statutes.
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I was Formerly a legal resident of T_rOY_ Miohi~~ ~
(City) (Stata) ~
318,~ ~IBat2181°Y8x18 LaU9 . Nowever I have changed my domi~ile r
and I resided at :
(Sireet and Number) ~ s
to and am and have been a bona fide resident cf t~~e State ot Florida since _ day of
Aug~~ 5~ 108 Cs~nina Streat~, ~i.ver Aark ~
. 19---, and I reside at
(Sireet and Number)
FORT PIERCE, SAtN~ LUCtE COUNTY, FIOftIDA
and ihis statement is to be taken as my declaration of citizenshi~, actual legal residence and domicile in the State of Florida.
(Insert he~e any pertinent facis, such as sale of property or business, or relinquishment ot empfoyment ;
at former domicile, removal of family to nev~ domicile, purchase of home, etc.)
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I FURTHER CERTIFY that I~vill comply with all other requirements of a(ega( :esident of this State. . ~
! FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
PIERCE, SAiNT LUCI~ COUNTY, FLORIDA, permanentiy.
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. . ~ - (Name)
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~ , i j: _ ~Ierlin G, Warr
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,.~''~"aY prn,~o~~.~nd subscribsd before me this ~ day of _ JBAUaP~t , ~q ~
ROGER POlTRAS
LERK Cl U!T COURT Notary Public -
BY ~ D.C. My Commission expires ~
(To Isa execuied in duplicate and originai filed with Clerk Circuit Cou~, and dupticate vrith Tax Asseswr.)
soox 1~5 35p . _