HomeMy WebLinkAbout0534 DeClaration of DOmicile and Citizenship
TQ THE STATE AND COUNTY TAX ASSESSOR,
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Sl. LUCtE C~tJNTY, FLORIDA:
This is my declaration of Domfcile a~~d Citizenship in the State of Florida that I am filhig this day in accordance and
in conformity with Chapter 222, Section 222.17, F!oricla Statutes.
I was formerly a fegal resident of LUCai~ille Ohi~
(City) (State)
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and ~ resided at _ _ _ However I have changed my domi~ile
!Street and Number)
to and am and have been a bona fide resident of the State nf Fforida since l~lth _ day of
_ MaY . , i9__ ~?5a~~ i reside ar 251.Q Acorn Street
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(Street and Number)
FORT PIERCE, 5AINT LUGE COUNTY, FLORIDA
end this statement is to be take~ as my declaration of citi2enship, actual legal residence and domicife in th~ State of Florida.
(Insert here any pertirrent facts, such as sale of property or busin~ss, or relinquishment of employment
at former domiciie, removal of family to new domicile, p~rchase o' home, etc.)
Entering child in school
. . ~ .
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lFtL AN EC R~£~~K
N. .
.lp¢c„eEl~
•ss c~~~~f z s~~ 2: a~
R4GE~ ~Oi i RaS. CL~RF:
S7. LUC4E COUNTY.
F~ORIOA
I FURTHER CERTIFY that I will camply with ail other requirements of a legal resident af this State.
,
I FURYH~,,C'~~6irl~Y that I have no intention to return to my former domiSile, and I intend to remain in FOR7
~ . °
PiERGE;~bAfNT•LU~~~'C~J~~Y, FLORIDA, permanently.
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, Yir~giriia 1~o~bs
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~ (Address;
Sworn to and subscribed befare me this ,,.~25th,_ day ef _._____~~y_ , i9 6~ .
,
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ROGER POITRA5 - ~ . -
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~tK CIRCUIT CQURT - ~ ~ ~ Notary Public
~ By _~.~._/__<-E''____f{=t'`=~~~ ~--':~=,~t~ ~ c.: -
---,T;~_, My Commission expires _
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(To be exec~ated in duplicate and Ofi~IFi#~i~'~~ ;~i ~ Clerk Cirsuit Caurt, a~d duptiute with Tax Assessor.)
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