HomeMy WebLinkAbout2016 Daclaration of Domicll~ ani! Citis~~shlp 1''76~$1
TO THE STATE AND COUNTY TAX ASS~'SSC)R, ~
Sl. tUC1E COUNTY, FtORIDA:
This is my declaration of Domiale and Citiz~r~ship i~ ths State of Horida that 1 am filin~ thi: day in sooordano~ and
in oonformity with Chapte? 222, Settio~ 222.17, FlorWa Statuhs.
1 was formerly a legal resident of waperosi ~OS~~•
(City) (Stah)
arx! 1 ~esided et R!• ~ . However 1 have thsn~st! my domidl~
(SNeet snd Number)
ro and am and have been a bona fide resident of the State of Florida since Aprii a day of
, 19~~, and I roside at R!. 1
(Streat and Number)
i~ORT M~, SAINT WCI~ COUNTY, RORIDA
and this stateme~t is to be taker~ as my decla~ation of citiunship, actual legal ~esidence and domiale in the Staro of Horida.
(Insert here any pe~tinent facts, such as sale of property or buainess, or relinquishment of emplayment
st former domicile, removal of family b new domiale, purchase of harie, etc.) ,
entering chiid in publie ~achooi t To~s~ Da~id Yorl~~
FILEO AND RECQR~Ep;
ST.~ECOR~ YERIF
EDLA.
1'76~81
9a~ii:2e ~
,'69 APR
- ~-~y~° ~
V
ROGEr~ POITRAS
CLERK CIRCUIT COURT:
i
:
1 ftJRTHER ~HtTiFY that I will aomply witfi aii othsr requirsments ot a le~al resident of this State.
1 RIRTHER CERTIFY that 1 have no intention to retum to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently.
~
me) OD~ YO=~ ~
~
~
(Add~ess)
Sworn to and su¢scribed before me this 9tb ~y ~ April . t9_~..
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