HomeMy WebLinkAbout0360 ~
t~eclar~tion taf Domi+cile ant! C~~izenship J`'
TO THE 5TATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FLORIDA
This is my declaration of l?omicile and Cit~zenship in the State of Florirla that I am filing this day in accordance and
in conformity with Chepter 222, Sectian 222.17, ~lorida 5tatutes.
I was formerly a legal resident of F~~~~ H111a ~(@]L~~t~___.
(City) (State)
and I resided ar 6~39 I±C}8 St2'98t. _ However i have changed my domiGle
(Street and humber)
to and am and have been a bona fide resident of the State of Florida since . day of
J~y ~'S 'T30 ~iroa~ ~'lvd, Port ~t. Lucie
- , 19__ , and I reside ar . - ~
(Street and Number)
PORT PIERCE, SAIN7 IUUE CQUNYY, 1=LORIDA
ar.d this statement is to be taken as my deciaration of citizenship, actual iegal residence and domicile in the 5tate of Florida.
(Insert here any pertinent facts, such as sale of proper?y or business, or relinquishment of employment
at former domicile, rei7~oval of family to new dom;cile, purchase af home, ett.}
F~?~Eq_~r~~ Ec
~~~~1~8~n~ r~sidence ' ' ' ~ ~~ED
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Ra~j '~uc,~ c~ ~ c~.ERK .
~ ~ FLDRIpqUNTY,
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1 FUR~`HER CERTIFY that I will camply with all other requirements af a legal resident of this State.
I FiJRTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
PIERCE, SA~NT IUCIE COUNTY, FLORlDA, permarentiy.
~ ' ' ' . ~ - -
, (Name) ~
; . ida~~r Ro~ley
_ ' _ ~Address)
2~ NoveMber 19 6~
Sworn to and substribed before me this _ day of _ , •
ltOGER POITRAS -
CIEItK C RCUfT COURI' Notary Public
gy __0~!.~!~± D.C. Mry Commission expires
(TQ be exetuted in dupiicate and origins{ fited with Clsrk Circuit Court, and duplicate with Tax Assessar.)
~ooK 13~ 354 ~
_ .