HomeMy WebLinkAbout2163~ooK 4 190
Declaration of Domicile and CitizenshipsT, IUCIE COUNTY, FLA.
TO THE STATE AND COUNTY TAX ASSESSOR,
ST. LIICIE COUNTY. FLORIDA:
This is my declaration of Domidle and Citizenship in the State of Florida that I am tiling this day in
accordance, and in conformity with Chapter 222, Section 222.17, Florida Statutes.
----------------. -------~+Y s---------------------
I was lormerly a legal resident of--------------1l1•Z-C•----~~q) ------------ (State)
- however, I have changed my domicile
and I resided at_-_--- 2984-__82011Z_~=~_ ~~~--A7[-__4E- -__--
(St:wt and Namber) 7th
to and am and have been a bona tide resident of the State of Florida since.. -- . -- - - . --------.day of
161 El__Sito Ct.-Port St. Lucie
-----Jay------------- -- 19- ~_, and I reside at------------------ -------.____----------------------------------------.
---------------- --+ (8trcet and Nnmt+er)
FT. PIERCE ----___-~ ST. LIICIE _ - __-- -~-------___--County, Florida,
------------------------- ------------- ------ -
(ati) - -
and thin statement is to be taken as my declaration of dtizenahip, actual legal residence and domicile in
the State of Florida.
(Insert here and pertinent facts. suh as sale as ruyertn i of ~ ~o~~'~nisbmant of emPlo~aNnt at
forme: domkile. removal 01 famil7 to new domicile. p rei,ase
.r.- _ - -.
9'~~'3~"
FILE ANQ RECOR D
III - , . -~u0~~\
ROGER POITRAS. C~f~K
~~ ~ 1 t
I FURTHER CERTIFY that I will reg~iater at m1 local address when the t~egistration hooka reopen,
and comply with all other requirements of a legal resident o! this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile. and I intend to ~~~~-
~ ~T_ PI1tBGE -~- ~ ~~-. LIICIE ,~,---_ _County, Florida,
ptiY• (fib) 1 ~¢,Q-PQ~
EATBSRII+it T<LJ.S -T-._______..
- (Adir...) --
Swo~tf+a ,
r • S /~ ~~
- - •~~ZQr
.:e~. ~ k y.t t ~ 0 .
~ -.. -,.
~~ m~e 17th dy ~
A. D. 19 ~
-: (ra e..zaevad is aosiieaa sad anal
s.w•e a.sv+s a.. r~.se cla. ~•. -
DEP, CKER,T
t,>Mel~ prwK beet. asd daptkste wits ~ Aaae.aer)