HomeMy WebLinkAbout0934Declaration of Domicile and Citlzeinship
181'793
TO THE STATE AND COUNTY TAX ASSESSOR,
St. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this dey in aooordanoe and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I wss formerly a legal resident of -~
(City) (State)
and 1 resided at __ ~~o ~ l l __ _. However I have changed my domicile
(Sheet and Number)
to snd am and have been a bona fide resident of the State of Florida since _ ~ day of
___ 19~, and 1 reside et ~~ 7~~-
~~~ p~ (Street ar~d Number
I~~TJN~ERf CE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Honda.
pnsert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of f~ new domicile, purchase of home, etc.)
~7 ~
a~
~""~
~Ctr, ~ cCaa ~~ti^"~1"
~r ~'
• ~t
/.S
~~
lD
~~_ ~
.~ •,
FILED AND RECORDED
ST. LUCIE COUNTY. FLA.
~E:CORD VERIF~E'D
181'793
~~~~
~~~
'69 AUG 13 PNI I :24
~t0:~£? i'0lTT COURT
I FURTHER CERTIFY that t will comply v~t~tEe~l~th~~~~~rements of s legal resident of this State.
t .FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in FORT
PIERCE,. SAINT LUCIE COUNTY, FLORIDA, permanently.
i::N:~::.Jr!!lt;.
..
... . 'j. •; i•
_ _ ~ ..'' ~ ~ . '' (Na
• - . 'p ~ (Address) .
.~ .G
r•',,
Sworn to and subsuibed before me this ~ day of , 19~~
ROGER POITRAS
CtERK CIRCUIT COURT
ey ~-~ `e~ D.C.
Re be execiNed in duplicate and original filed with Clerk Circuit Court, and cafe with Tex Afaaaora
SooK x.79 ~ 33
~. ,~
Notary Public
My Commission expires
.__ 4 _ F