HomeMy WebLinkAbout2112 Declaration of Domicile and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
This is my declaration of Jom~cile and Citizenship in the State ef Florida that I am filing this day in accordance and
in conformity with Chapter 222, SeUion 222.17, Florida Starutes
; was formerly a lega! resident of ~~~~'E . - N'- -
(City) (State)
and I resided at 1l~3 Garth Rd. However I have changed my domi~il~
(5?reet and Number)
to and am and have been a bona fide resident of the State of Florida since a7~ - day of
DeC~tbe~' , 19_~5 , and I reside at ?5~1 ThtmbpoiAt, Ih`. _
- - - - -
{Street and Number)
FORT PiERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domitile in the State of Floride.
(Insert here an~~~ pertinent facts, such as sale of property or business, or relinquishmen+ of employment
at former domicile, removal cf famify to ne~v dornicile, purchase of home, etc.)
FILIN(3 ~'OR HQrIESTF.fID PiJ~
FILED ~.~JD REC DED
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I FUP.THER CERTIFY thafi I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no inten!ion to return to my former domi4ile, and I intend to reniain in FC~RT
PIERCg, S<iINT ~UCiE COUNTY, FLOR~DA, permanently.
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1 t C b~~~~iii~ - - - -
; (Name)
_ .,~y~~ ~ t.'1s•
• ~ : ~,R'IrAUR B~C3.TLR
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-;,~~v~ 28th ~ece~ber 65
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~`to and subscribed before me thi; day of 19_.~_.
i r,
ROGER POI S -
CI~RK IR I COURT Notary Public
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gy _ _ _ D.C. My Commission expires -
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t ~ (To be exec in dvplicate and originml filed with Clerk Circuit Court, and dupiisste with 'fax Assessar.)
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