HomeMy WebLinkAbout2702 Deci~ration ot Domicile and Citizenship
:~ss~_is
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
This is my declarotion of Domicile and Citizenship in the State of Florida that 1 am filing this day in attordanca and
~n conformity with Chapter 222, Section 222.17, Flo~ida Statutes.
I was forme~ly a legal resident of ~~~,.,p~ ~=~:-C~-~/ G~~ rt~1~j -
-r~~
~~~ty~ (State)
and 1 resided at ~ ` However I have changed my domitile
(Street and Number)
,bf
to and am and have been a bona fide resident of the State of Florida since /Z day of
~ , 19~
~ , and I reside at ~ ~ ~ /GO~
~ (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 property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
• • ~ STt LE~ AN~ RFC
~ ;~~C~E ~pV ORDED
f._ ~ NT1' F~A.
i~?r..~i.~
'68 ~~91.~g
26 p~ ~:SO
:
, C~`RK'CIRC ; Rys ;
Ut7 COVRT `
;
~ ~
~
~
t -
1 FURTHER ~ERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that 1 have no intention To return to my former domiCile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanentty.
' .,:uu;,
: ~G;
;;;;~i
-V~~ . i~ X ~S~P~Nam~ ~
. , CA~2/Irr!'e
- - . ~ G:.J
~ " ~ j ' . i ~ ' _
~ ' ~ ' ~ (Address)
' ~ ~ ~ .
/ ~ C4
`{'C ( ~ • ~ : ~ ~C~ - O
~~~worn~to:arid subscribed before me this day of . 19
~ ROGER POITRAS
K CIRCUIT COURT Notary Public ~ '
~ a.~-~,t~ C.~C~c-,Q=C~ ~
gy D.C. My Commission expires !
~
_ ~
(To b~ ~xecut~d in duplicah and originsl filed with O R Grcvit Court, and dupliuts with Tax Assessor.) `
;
d00K172 PACE~6~6
F.lo 13 - - - . .
;x
~
_ , . -..r~-- -
-~.~<'~9 •E-~~~ry'.~^. . 1' ~ a
~s~u..YS.'~cs,~'+,:II~.~w._., ~ . xe y_ _ ` _