HomeMy WebLinkAbout0775 Declaratio~ ot Domicile and Citizenshlp ~
TO THE STATE AND COUNTY TAX ASSESSOR, 1`~~~~'~ ~
5~ . LUCIE COUNTY, FIORIDA:
This is my declaraiion of Domicile and Citizenship in the State of Florida that { am filing this day in atcordance anti
in conformity with Chapter 222, 5ectio~ 222.17, Florida Statutea.
I was formerly a legal resident of DeYlIDBT~~---_._-_------_~_
(City) (State)
and i resided at Howevrr I have changed my domiGfe
~ (5treet and Number)
b and am and have been a bona fide resident of the State of Florida since ..v-- day of
P 5104 Oleander Avenue
_ Se tembeT i9~v65and { reside at _
(Street and Number)
fORT ~IErtCE. SAiNT LUClE COUNTY, FLQRIDA
and this statemenf is to be taken as my declaratior. of citizenship, actual lega! residence and domicile in the State of Florida.
pnsert here any pertinent facts, such as sale af property or business, or reiinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Entering children in $chool in Elementary ~
establishing residence ~~t~~~ DEO
~300K
. 's~ ~cr s ~ ; y 9
Applying for American Citizenship ~
ROG~R POITRAS,
ST. LUCIE COUNTYRK
FLORl~A
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1 FURTHER CERTIFY that I will comply with all other requirements of a IeQal resident of.tf~tis~ ~~r.:
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f FUR7HER CERTIFY that I have no intention to return tc my former domi4ile, and I iniend iou:~eCtib"rri:;~p`_~R'~'..
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~1~%Il~,~~~,.LV•.i. _
PlERC~, SAINT LUCIE COUNTY, FLORIDA, permanently.
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:,~L;=.~...:. : - = (Name)
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~~~J~'Bi~tN~:~e~l.substribed before me this _ day of - OCtObeZ` , 19
ROGER POITftAS
CLERK CI T COURT Notary Public
; ~
~ gy D.C. My Commission expires
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. (To br ~x~cuh~d in dvpliuro and o~iyinsl ~iled with Cl~rk Circ~it~C~u~~nd duplq~~ith Tax Ass~so?.)
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