HomeMy WebLinkAbout0650 , ~.r `
declaration of Domicile and Citi~ren~ship v
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TO TWE STATE AND COUNTY TAX ASSESSOR, ~
Sl. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile anci Citizenship in the 5tate of Florida that I am fili~y tnis day in accordante and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of ~~~~s~r_t Indiana
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(City) (State)
- 2018 High Street
and I resided at _ . . _ _ _ _ _ However I have changed my domi~ile
(Street and Number)
1
to and am and have been a bona fide resident of the 5tate cf Florida since _ day of
Julq 65 152 whispering ~reek ~~11age
- _ . 19__. , and I reside at _
(Street and Number)
FORt PIERCE, SAINT LUCIE COUNTY, FLORIDA
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and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile.ir~tNe~l#~te:of Flqrida.
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(Insert here any pertinent facts, such as sale of property or business, or relinquishmenx:of`~Ptiptoyment
at former domicile, removal of family to new domicile, purchase of home, etc.) t'. ~ ~
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Establishing residence ~ Frs= ,j
- ~-t..J~t
ROGER PO~TRAS. CL~RK •
ST. LUCtE CaUl~TY,
FLORlDA
I FURTHER CERTIFY that I wiii comply v+rith all other requirements of a fegal resident of this 5tate.
I FURTHER CERTIFY that I have no intention ta return to my former domic,ile, and I intend to remain in FOR7
PIERCE, SAIN7 LUCIE COUlVTY, FLORIDA, permanently.
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, . , ~ (Name)
~ Frank G. Lufcy
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~ ~ _ (Address)
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Sworn to and substribed before me ?his 4~-_-_- day of ~CtObErt9 6S
ROGER POITRAS - -
CLEIfK CIRC T COURT Notary Public
gy D.C. My Commi3sion expires _ -
lYo be execu4ed in duplicate and original filed with Clerk Circuit Court, and dupliata with Tax Assessor.)
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