HomeMy WebLinkAbout2118i~clarakion of Lomicile aid Citizellehip
~oRK 52 f~s~ 54
TO THE STATE ANL~ COUNTY TAX ASS>~SOR, .
3T. LUCIE COUNTY, FLORIDA:
ST. tri~C~E E~~'N'~- ~1 A.
This is my declaralion o! Domicile and Citizenship ir, the State o[ Florida that I am filing thL~ day in accordance
and in conformity with Chapter 222, Secticn 224.17, Florida Statutes.
I was formerly a legal resident of Cicero
[city)
w222 S 58 th Ave:.un
and I resided at
(Street :.:-d N~amberl l3
to and am and have been a bona fide resident of the State of Florida since _____
lleo ember 82
19, ~, and I reside at
Port ~t ~ Lucie
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA,
Illinois
state
However, I have changed cny domicile
300 Airoso Blvd
day of
[Street a;id Number]
and this state:tient is to be taken ns my declaration of citizenship, actunl legal restdence and domicile in the State of Florida.
[Insert here any pertinent facts, such as ssle of property or business, or relinquishment of emplo3anent
at former domicile, removal of family to new domicile. p:arch~se of home, ete•~
~steblishing residency
1~.~~ a2
FlLEO AN REC~Q3GOK
~~- •
1962 DEC 14 RM i I : 57
ROGER POITRAS. CIERK
gT, LUCIE COUNT`(, FLORIDA
Q ~~
'., ') ,
~ ~ ~ ~ ~
-I FURTIi1c,R CERTIFY that I wUl register at my local address when the registration b~oka r~I~en, s^.d comply
wit~•tt1~ oth ~ ~t~rements of a legal resident of this State.
w i
:~ #.~o;'~~~~C'ERTIFY that I have no intention to return to m:• former domicile, and I intend to remain in
~.i t ' ~.
PAB.~I`~P~C~ ~~.~'::LUCIE COUNTY, FLORIDA, permanently.
-~ .-~~ _ -
_:;,~. - [Address)
,_,-
worn to and subscribed before me this- ~'4 fay of I?ecemb®r ~ _, ig~_
ROGER FOITRAS
CLF1tFC C~$CUIT COJRT
• Notary Public
t~ty Commtss;nn expires-
[~'o be eacecated In duplicate and t+risiual filed with ^ixrk rircait Cotart, and duplicate wlin Taz Ass~cor]