HomeMy WebLinkAbout1012 1~'~17;,3
Decla~ation ot Domicll~ and Citisenship ~
TO THE STATE AND COUNTY TAX ASSESSOR, ~
Si . WCIE COUNTY, FLORIDA: ~
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This is my decla~ation of Domicile and Gitize~ship i~ ths Stata of Flo~ids thst i am filing this day in aooo~dance and ~
~n conformity with Chapter 222, Section 222.17, Flo~ida Statutes. !
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1 was formeriy a legal resident of ~LI~
(~iy) ~a~) i
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and I resided at . However 1 have chsnqsd my domidle ~
(Street and Number) ~
to and am and have been a bons fide resident of the State of Florida since dey of ~
, ~
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~pr31 56 22oG S. 3~tth St. ~
_ , 19 , and I reside at
(Shest and Numbe~r)
fORT ~tERCE, SAINT LUCIE COtINTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal re:idencs and domicile in the State of Horida.
(Insert here any pe~tinent fads, auch as sale of property or busineu, or relinquishment of employment
st former domicile, ~emoval of family to new domicile, purd~ass of home, etc.)
FILII~ I~OR H(MffiTEAD P(TRE'OSSS
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f1L,Ep ANO REt:6RR9E8~
8T. lUClE COUNTT t~iJ1.`'•
~coao vEa~~~o1~,73
'67 J~Ut 2S AM I I: SO .
ROGER POlTRAS
~.ERK CIRCUII ~OUR3'
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1 RJRTHER ~ERTIFlf that I will oomply with all other ~squiremenri of a leya( rssident of this State.
~ ! FURTHER CERTIFY that I have no intention to retum to my forme~ domicjle, and 1 intend to remain in fORT
PIERCE, SA(NT LUCIE COUNTY, FLORIDA, permanently.
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I (Name)
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~ Jwt4ES PLDNKBTT
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~ i w ,~rofn}to=and iubsuibcd before me this 25~ day of = J~~ , 19 6?
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` Notary Public
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, By D.C. My Commission expires
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i Ro b~ in duplical~ and or~inal fil~d wilh Cl~ric Cirwh Couet, and dupliul~ wilb Tax AsNaor.)
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