HomeMy WebLinkAbout2903 Declaratio~ ot Dornicile and Citisenship -165~~~
TO THE STATE AND COUNTY TAX ASSESSOR,
51. IUCIE ~OUNTY, FIORIDA:
This is my declaration of ~omicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes. .
1 was formerly a legal resident of _ _ _ _ _ _ . _ _ _~e@~V £ - ~
(C~ty) (State)
and I ~esided at _ _ _ _ _ _ _ _ _ _ ~ B.I2 Bng 3$~___ _ _ _ _ . However I have changed my domiCile
(Street and Numbe~)
to and am and have been a bona fide resident of the State of Florida since -_---25~_ _ day of
- July 19
67 , and I reside at _-??OT SUDI13! Blvd~
(Street and Number) ~
FORT PIERCE, 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 properry or business, or relinquishment of employment !
at former domicile, removal of family to new domicile, purchase of home, etc.)
intering child in school
R~CQ~
B~LA•
~ILE~ AN~ V'a
ST. I.UCtE ~ ~ _ "r~
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F ia ~ ~o : ?9 -
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~OUR
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E CLERK ~IR
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I FURTHER CERTIFY that I 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 domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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Y ~An/~
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~ : Sw9rn tFaead'subscribed before me this 18tb- day of MarCh , 19~18. '
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LL . ~ I J • . ~ . 1
, ' . ROGER POITRAS : -
' U.~RK CIRC~IT~CDURT Notary Public
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~ By ~~i~J
~ .JrP~' ~~(J_ D.C. My Commission expires
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.~To b~ ~xecuted in dupliuta and ori~inal filed with Cltrlc Grcuit Courf, and duplicst~ with Tax Ass~sso~.)
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