HomeMy WebLinkAbout2987Dieclaratlon of Domicile and Cltlsenship 1~3-2'?'S
TO THE STATE AND COUNTY TAX ASSESSOR, -
S1. lUC1E COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the Stats of Florida that 1 am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of
ity)
--- - _ i
and 1 resided at
/~~~
/l
(Sta»)
However 1 have changed my domicjls
(Street and Number) ~
to and am and have been a bona fide resident of the State of Florida since -.~_ day of
19~Q_.~, and I reside at
(Str nd Number Pa
FORT PIERCE, 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 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.)
RILED AND RECORDS ~ s
IUCIE COUNTY'.
i8 Z~ASM t0: 17
69 SEP
~~
upr~ _? 4'01 R1.S
CLERK CIRCUIT COURT_
,~ ,tea .~.;,
ST.R~CORD VERI~-EO
~ ~ ~a ~~~~
I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicjle, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~• • .-~
.
•
~,~ :
_ ." ,. Y (Address)
;~-.- :
•.~~`t' ~ c.~`;:>. ~_~~°y ,~'~+ ~
thi
ib
d b
f
~
,
~
}
b
day of /
, 19,`2.
s
ore me
e
e
~
ptp
~
;
su
u
.• :\=.
,~t~t:..
ROGER POITRAS
CLERK CIRCUIT COURT Notary Public
D
C Commission expires
M
gy
.
. y
(To be executed in duplicate and original filed with Cleric Cirwit Court, and duplicate with Tax Armor.)
°soac179 ~2~85
No. 13