HomeMy WebLinkAbout0145 Declaration ot Domicile and Citise~ship -
TO THE STATE AND COUNTY TAX ASSESSOR. 15-~583
ST. lUC1E COUNTY, FLORIOA: ~
This is my declaration of Dom+cile and Citizenship in the State of Florida that 1 am filin~ this day in aooordanos and
in co~formity with Chapter 222, Section 222.17, Fiorida Statutes.
1 was formerly a lagal resident of K~~ ~ ~b~~
~ . (City) (State)
and I resided at ~9 Qel~dun ~venne .~,,,eV~ ~~~e ~n~d ~,y dom~cils _
~ (Street and ~ Number) ~
b and am a~d hsve been a bona fide resident of the State of Flarida since _ i5 day of
Noveanber 170? Ponae ~e Leon Prado
, 1~ , and 1 reside at
(Street and Number)
FORT ~IERCE, 5111NT LUCIE COUNTY, RORIOA
and this ststement is to be taken as my declsration of dtizenship, actval (egal residence and donnicile in the Stab of Horida.
(Insert he~e 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.) _
- F~tEO AND RECOAD6p
ST. LUCIE COUNTY~ ~
RECORO VERIFI~~
Establishing residence . ~l ~a~ 5 PM !Z ; Z 1
- _ - 15i583
t'ocF ~ ~o~rRas
CLERK CIRCUIT COURT
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1 RIRTHER CERTIFY that 1 wil) aomply witfi all other requiremenit of s legat resident of thls State.
I FURTHER CERTIFY that 1 have no intention to return to my former domitile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently.
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„ y Jannary , 19~Z.
3worn ro and subsuibed before me this 5 da of
ROGER POITRAS
CI UR COURT Notary Public
gy D.C. My Commission expires
(To b~ ~x~cul~d ie duplieata and ori~in~ fil~d with Cl~rk Circuit Co~r~, and duplicaM wHk Tax Ass~aora
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