HomeMy WebLinkAbout2633 DeClar~r~ion ai Domi~ite a~d Citizenship
1'O THE STATE AND COUNTY TAX ASSE550R, ~;,v ~
Sl. IUCIE COUNTY, FIORIDA: ~
1'nis is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordanca and
in conformity with Chapter 222, Scrtion 222.17, Florida Statutes.
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Hew Y'ark C~ty New York
I was farmerly a Isgal resident nf _ _ _ _ . -
(City) (Sfate)
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and 1 resided ar 3128 Cor lea~r /~V~Ylt2L' However I have changed my domic.ile
~ _ _ _ - - - _
(Street and Number)
to end am and have been a bona fida resident of the Stais of Florida since . _ 9 _-.f.___ day of
Apzi2 ~5 102 Nar~?a~~u Ave~r~ae
- - - , 19- and I reside at
(5treet and Number}
FOJtT PlERZE, SAINT LUCIE COUNT1f, FtORIDA
and this statement is to be taken as my detlaration of citizenship, actual legal residence and domicile in the State of Flarida.
(lnsert here any pertinens facts, such as sale of property or business, or relinquishment of empfoyment
st former domicile, removal of family to new domicile, purchase of home, etc.)
Establishing residence
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1 FURTHER CERTIFY that I will comply with a!! other requ)rements of a legal resident of this State.
I FUR7HER CERTIFY that ! have no intenticn to return to my former domiGile, and I intend to remain in FORT
PI~RCE, SAINT LUC1E COUIVTY, FLURIUA, permanently.
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Sworn ta anc~ subscribed before rne this day of ~q
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ROGER POITRAS =.~7. ~t-'~'~-D'~"'"
CLERK CIRCUIT tOURT ~I~ ~y ~vbl ~ }
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~Y , D.C. My Commissior~ ~es '
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(To be ~xecuted in duplicate and original fited veriti? C1erk Ci~cvit Court, snd duplicat~ with Tax As~ssor.)
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