HomeMy WebLinkAbout2062 -
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- ~ Declaration ot Domicile ~nd Citizenship
To ~E sTa~ ~r~ro couNnr TAx ass~sso~, ~
sT. ~unE couNnr, aoaio~:
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1'hls is my declaratior? of Oomidl• and CitlZenship t~r the St~te of FlorWa that I am filinq thit day in aooords~os and
In aonformtty with Chapter 722, Section 22?,17, Florida Statutes. ~ •
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1 was formerl 1 ~
y a yal rosi~ent ~f
(City) ~ (State)
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and 1 rosidsd at ~ 3 ~ However t have~cha doml !e
~ n~ed my ~
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~ to and am and hsvs besn a bons fWs rostdent of ths Ststs of F{ori sinoe ~ day of
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19 v, and 1 rsside d ~ .
, . (Street and Numbsr)
1°ORT MERCE, SA1NT LUCIE COUNTY, l~LORtDA .
~ end this statemsnt i: b bs teken as my dscla~atior~ of dtizanship, actusl le~aal rssidenca and domidle in fhs State of Fiortda.
(Insert here any psrtinent facts, such as ~le of propsrty or budneu, or rolinquishms~t of employme~t
~ at formsr domkils, romoval of famity to nsw domkile, purchase of home, stc.)
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~js~:~~:'~~.+, i 1964Q1tG !7 ANI1: ii
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. . • , ROGER POtTRAS, CIERK
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~ S1. . LORtDA
~ ; . t, ~ ~ lUCIE COUN1
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ti•-, ~~='f.Ft1i~HER CER'fiFY that f wilt oomply with
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aIT ~t~r ~quiremenri of a legai resident of this State.
, 1 FURTHER CERTIFY that I~iave no intention to return to my farmer domi~ile, and 1 tnte~d to ~emaln in FORT
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PIERCE, SAIfVT LUCIE COUNTY, FLORIDA, permanently. ~
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~ : bvNbA~?a and wbsaribed befor~ me thfs da of '
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; ROGER ~ORRAf
i CLERK CtJR COURT ~ ~ Notary Pubik
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; 8Y O.C. My commtsston expires
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~ lTe b~ nacut~d [n dupttcat~ and ori~inal Af~d whi~ Cf~h Ciraiit Cewf, and d~piieah wbb Tax As~ora
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