HomeMy WebLinkAbout2366 Decl~ration of Domicile and Citizenship
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TO 7HE Sl'ATE AND COUNYY TAX ASSESSC~R, ~
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Sl. LUCIE COUNTY, FIORIDA i
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This +s my declaration of Domirile and Citizenship in the State ot Elorida tha! I am filing this day in accordance and ;
in confnrmity with Chapter 222, Sectien 222.17, Florida Statutes. ~
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i was formerly a legal resident of Bl"O~klyn N~~ y~
(City) (State)
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and I resided at _~8 ~bt°h S$1'1,6$ _ _ However I have changed my domi~ile `
(Street and Number)
to and am an~ hav~ been a bona fide resident of the State of Fiorida since day of
--~4~1b9x' , 1~~~_ , and I reside at . ~1I@._Q__,_ ~
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, ~LBRIDA
and this statement is to be taken as my declaration of citizenship, actual lega! residence and domicile in the State of Florida.
(Insert here any pertinent fact~, such as sale o`r property or business, or relinquishment of employment
at former domitile, removal of far~~ily to new domicile, purchase of tiome, etc.)
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i FURTH~R CERTIFY that I will compiy with all other requirements of a legai resident of this State.
I FURTHER CERTIFY that I have no intention to return to my farmer domi~ile, and I intend to rernain in FORT
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PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. t
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: Franc~s ~hl• '
. (Name)
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• _ (Address) :
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5worn~rc5'and suhscribed before me this day of ~~~~r___ , 19 . ~
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ROGER POITRAS ~
CIERK CIRCUIT COURT Notary Public
gy - - D.C. My Commission expires -
(T~ be executed in duplicste snd origina) filed with Cletk Circuit Caurt, and duplitate with Tax 1Asses*ar.)
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