HomeMy WebLinkAbout0973 . {
Daclarat~on ot Dornicile antl Citisenship
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FlOR10A:
This is my declaration of Oomicile and Citizenship i~ the State of Ffor~da that 1 am filinq this day in aooordsnos a~d
in co~formity with Chapter 222, Sectior? 22Z.17, Florida Statutes.
I was formerly a Ieqal resident of - Red~aod Citi ~aliforais
(CitY) (State)
and 1 ~esided at 1031 HIKiiOa $ttee! However 1 have chanqed my domitile
(Street and Number)
to and am and have bee~ a bona fide resident of the State of Fiorida sinos llth ~ day af
19 6~ , and 1 mside at Rt 3 Bo7t a99
(Shaet and Number)
FORT PIERCE, SAINT LUCtE COUNTY, RORiDA
artd this statement is to be taken as my decla~ation of citizenship, actuat legal residenoe and domicile in the State of Ho~ida.
(Insert here any pertinent facts, such as sale of property or business, or ~elinquishment of emptoyment
at former domicile, removal of family to new domiciie, purchase of home, etc.)
Sntering chiidren in school~
AND RECOa~ED
Lanra ia the ist grsde F~LED ~LA•
, g?, l.UC1E ~ vEp F~ 0
a~coR;~~
~ Jobn io the 7t1~ ~rade 1 : y6
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~o~~~ P~~~ cova~~ .
, c~aK c~RCU?~ '
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.
I FURTHER CEitTIFY that 1 will comply with all other requtrements of a I~al resident of this State.
I FURTHER CER7IFY that 1 have no intention to retum to my former domic,ile, and I intend to remain in FORT
PlERCE,'~SA1NT LUClE COUNTY, FLORIDA, pemnanently.
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''~J~'t"C-5wa`J~~fo.and wbsuibed.before ms this 1Ztb day of - ~ .
ROGcR POITRAS
K CIitCUtT COURT . Notary PuWic
By °'`'''~'G O.C. My Commission axpiras
(To bs ~xawt~d iA duplicat~ and original fitod witb CiKlc Circuit Cou~l, and dvplicat~ witb Y
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