HomeMy WebLinkAbout0779 Declaration ot Domicile and Citlzensh~p 1~?~841
TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FIORIDA:
This is my declarotion of Domicile and Citizenship in the State of Flo~ida that 1 am filing thia dsy in accordanoe and
~n oonformiy with ~hapter 222,. Section 222.17, Florida Statutes.
I was formerly a iegal resident of C~ C - ~~D/~~~
(City) (State)
~
and I resided at However I hsve changed my domiG~e
(Sireat a~d Number)
to and am and have been a bona fide resident of the State of Florids since day of
_ _ _ , 19~, and I reside at ~ ~a+'~ ~ ~r N vG/a~
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this staterr~ent is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida. c
(Insert here any pertinent fads, such as sale of property or busineu, or relinquishment of employment ~
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at former domicile, removal of family to new domicile, purchase of home, etc.) ~
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FILED ANO RECORDEO
S7 LUCIE COUNTY FLa.
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CLER j R~+S
K CIRCUIT COURT
I RJRTHER CERTIFY that I will aomply with all other requirements of s le~al resident of this Stste.
I FURTHER CERTIFY that I have no intention to retum to my former domitile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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v ed.~~ • o~e 2 Z-
~ (Address)
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Sworn t~ and substribed before me this day ; N%~' .1l F"'
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RO~iER POITR/1S • _ ~ ~
C~ERK CIRCUIT COURT Not Public =v ~ ~ : ~ = .
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gy D.C. My Gommiuion expires . ~ . f ` ~ ~ ~
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Ro b~ ~x~cut~d in duplicat~ and ai~esl fil~d wkh G~ic Cirarif Couif, and duplicat~ witb Tax As~or.) ~
d00K 17~ PACE .7~~
?yo. 19 ~
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