HomeMy WebLinkAbout0659 Declaration ot Domicile and Citizenship ~
14335'7
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FIORIDA:
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This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in atcordsnce and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
Ship Hottoa New Jersey
I was formerly a legat ~esident of -
(City) (State)
and 1 resided at __19th & Cgpt ral _ However I have changed my domici~e
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _ 23 day of
November 65j1 3406 Abbott Street
_ _ _ _ _ , 19-__, and I reside at
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here any pertine~t facts, such as sale of property or business, or refinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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143357'
R~GER P~1 i s;AS. CLERK ~
Establishing reside nce ST• ~UCIE COUNT Y.
FLORIOA
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I FURTHER CERTIFY that I will comply with all other requirements of a legal ~esident of tliii~ _
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1 FURTHER CERTIFY that I have no intention to retum to my former domiCile, and I interfd;to~'remain~+n F.ORT
PIERCE, SAINT LUCIE CAUNTY, FIORIDA, permanently.
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~ ~5worn to and subscribed before me this day of , 19 .
ROGER POITRAS
CIR IT COU Notary Public
By ' D.C. My Commission expires
(To b~ ~x~cutad in dupliuts snd ori~inal filed with Cl~vk C'ircuit Carr1, and duptiut~ with Tax Aa~s~or.)
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