HomeMy WebLinkAbout0341 Declaration ot Domicile and Cilizens~ip ~
1'~J ii-~E STATE AND COUNTY TAX A55ESSOR,
Sl. LUCIE COUNTY, FLORIbA: ,
This is rr~y deciaration of Dom~cile and Citizenship in the State of Ffori~a that I am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
{ was formerly a legal resident of Ba~ r~ ~~rit11C1C~_____ _
(C~ty) (State)
and I resided at _ Nex H8~eri Rt 1 HnwevPr I have thanged my domiCile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since 18~h _ day of
Novem~er ~ 9 65 and I reside at S~il fish Est. So 2~thSt
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(Street and Number)
FORT PIERCE, SAINT LUClE COUNTY, FLORlDA
and this statement is ta be taken as my declaratian of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicife, removal of famiiy to ne~,v domicile, purchase of home, etc.)
~nterir~ children in sc~hoo~
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I FURTHER CERTIFY that I will comply with all other requiremenis of a legal resident of fhis State.
I FUR7HER CERTIFY that I have no intention ta return to my former domi4ile, and I intend to remain in FORT
PIERCE, SAINF, lUC°IE COUNTY, FLORIDA, permanently.
. x. .~n~.-,u,.~..~.~~^-<-~.~-~-~..` _
(Name}
' ' • xsrion I~a~ Dnrbin
; - - _
- ~ (Address)
22nd gove~ber t55
Swom to and subscribed before me this _ day of , 19 .
RQGER POITRAS -
C K CIRCUI"t CQURT lVatary Public
By--- D.C. My Commission exp:res
(To be executed in duplic~te and ori$in~) ~il~id ~~`Cterk Cir~'~x„~urt, and dapliute with Tax As~stor.)
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