HomeMy WebLinkAbout0515 ~
DeClaration ot Domtcile and Citizenshlp 15~44~
TO THE STATE AND COUNTY TAX ASSESSOR,
51. lUC1E COUNTY, FtORIDA:
This is my decla~ation of Domicife and Citizenship in the State of Florida that i arr. f::ing this day in actordaRC.e and
~n conformiry with Chapter 222, Section 222,17, Florida Statutes.
I was forme~ly a legal residen+ of -~(11Ci1(1~~~__________ _ ~/f-/L7 _
(City) (State) ~
and 1 resided at s~7~ll ___E~~-E~~/~j ~ j{~~ Howe~ar 1 have changed my domicjle
(Street and Number)
tQ and am and have been a bona fide resident of the State of Florida si~ce .______~sG~?._.__ day of
-~s-~ , 19...~~2, and I reside at ~~~Q.~iS' irva~~ ~iE~ a~i.~
(Streer and Numbe~)
FORt PlERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration 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 domicile, removal of family to new domicile, purchase of home, etc.)
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PU~2 ~ 1~ fl S E~ ft /~o~I ~
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-Fl1.~0 AND RE:
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. ~~RECO~RD V Rlfl~p t
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- ~ _ . 1 66 OEC 30 p~ ~ :1~
. . ~ 15144
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= - ~ ~ ` ROGER POITRAS
= ~ , CLERK CIRCUIT COURT '
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I FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
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I FURTHER CERTIFY that I have no intention to return to my former domiule, and I intend to remain in FORT ~
PIERCE, SAtNT LUCIE COUNN, FLC?RIDA, permanently.
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(Name) %
_ (Address) ~
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Swom to and subscribed before me this ~ day of ,~q_~ €
~
OGER POIT
K UtT URT Notary Public
8Y .C. My Commission expires
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(To b~ ~xecuted duplicat~ and original filed with Cterk Grcuit Court, snd dupliut~ with Tax Ass~stor.)
~~163 ~ 510 '
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