HomeMy WebLinkAbout0520 Decl~r~tion af ~amiciie and Citizer~ship ~
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TO TNE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, PLORIDA: ~
This is my declaraiion of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Siatutes.
I was formerly a legal resident of ~ ~hQ~Q Nex York
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(City) (State)
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Bald~.n Pl,aea Rd• However I have chan ed m domi~ile
and I resided at - - - - - 9 Y
~ (Street and Number)
to and am and have been a bona fide resident of,the State of Florida since l~t.. day of
`'T~'~ 19__bs, and I reside at _--ll~ _B~&Ch COU2''~i
- - - - - - ~S~~ee~ a~s~ Number)
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' FORT PIERCE, SAINT LUCIE COUNTY, FLOitIDA ~
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and this statement is to be taken as my declaration of citizenship, aciual legal residence and domicile in the State of Florida. '
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
New Domicile
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~ I FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this Stafe.
; I FU~CTHER CERTIFY that I have no intention to return to my former domiSile, and I intend to remain in ~ORT
+
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
. . _ . .
. , ' ' ~ Jock MacDonald ~
, . , ,
~ (Name)
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• , • (Address)
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Sworn to and subscribed bsfore me this day of - J~~~ , 19
R9G@R POiTRAS
CLERK CIRGUIT COURT Notary Public
gy ~ D.C. My Commissian expires
.
~ (To be executed in duplicate and originst filed w3th Cterk Circuit Court, and dupticate with Tax Assessor.)
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