HomeMy WebLinkAbout2258 Declaratlon o! Domjcfle and C~itisenship ~
TO ?HE STATE AND COUNTY TAX ASSES50R, I'~~~1_~~
51. LUCIE COUNTY, FIORiDA:
This is my d~c.laration of Domicile and Citizenship in th~ State of Florida that I am fiiing this day in accordence and
~n conformity with Chapter 222, Section 222.17, Fiorida Statutes.
1 was formerly a le~al reside~t of - - _ - - _ T~_ .
(City? (State)
and I resided at _ 6~ GY'a11d ~iatrr. Ih"iv~e__. . Howev~r I have changCo my domi~ile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since 30#h - day of
~p~1be~'. , 1~~. , and I ~eside at ~._+~_B4Z_~~~Q ~ T~~tOOd~-
{Street and Number) ~
FOR7 PiERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is t~ 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 ot property or business, or relinquishment of employment
at former domicile, remova( af family to new domicile, purchase of home, etc.)
. Establiahing rasidence
- ~IL~~A ~DED
~QOK
" . ' ~ -~fyt " V
'65 ~d0~1 12~~~~~49
1~{ ~
ROGE?t ~ ~~-ERK
ST. LUCIE CCUNTY,
~~oRiDa
I FURTHER CERFIFY that I wiil comply with a!I other r~equirements of a legal resident of this State.
I FURTHER CERTIFY ihat I have no intention to return to my former domic,~le, and t intend to remain in ~ORT
PlERCE, SAINT LUClE COUNTY, FLORIbA, permanently.
• . . ~ ~ c~.
. Le~ ~.Jo~~1e)
~ . -f
~ , " . , (Address!
. ~
_ ~ ~
Novea~ber
Sworn~ tG and s;.rbscribed before me this _~~th day af , i 9~
ROGER POITRAS ~
K ClittUfT~OUkT Notary Pubiic
By G' ~""~L~' D.C. My Commission expires
(To bs sxecuted in duplicate and origina) filed with Clsrk Circui! C~ourt, and duplicste with Tax Assessor.)
BoaK ~30 459