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~ D~rclaration af ~ Domicll• and Citis~nship ~
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TO THE 5TATE AND COUNTY TAX A5SESSUR,
_ Sl. LUCIE COUNTY, FIORIDA: '
~ This is my declaration of Domicile and Citizenship in tha State of Florida that I am filing this day in accordance bnd
in conformity with Chapte~ ?22, Section 222.17, Floride Statutts.
1 was formerly a legal residemt of ___.PY._~~t _ Al~~~ _
(City) (Sraro)
BOt la~ Hawever I have cha m domicile
and 1 resided at - ~9~ Y
(5ireet and Number)
ro and am end have been a bona fide resident of the 5tate of Florida since lat~ day of
______S~~t~~ber____ ~q 6S_, and 1 reside at 53t S~4th Nows1l[ Mitel
(Street and Number)
FORT PIERCE, 5AINT LUCIE COUNTY, FLORIDA
and this stetement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property ar business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Bntering T~vo Children in Schooi -
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~ 1 FURTHER CERTiFY that I will comply with all other re~quiremer?ts of a legal resident of this State.
1 FURTWER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIUA, permaner.tly.
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Swb~r1'~o,and subscribed before me this 13th day of 5~~.~~r , 19~_.
i
ROGEIt POITRAS
CLERK CIRCUlT QURT Notary Public
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dy ~ ~~y ''V~~ D.C. My C~mmissi~n ex'ires
(To be ~xttut~d in duplicate and o~iqinbl ~il~d wrth Ci~rk Circuit Gourt, snd dupli~ wilfi Tax Ass~rswr.)
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