HomeMy WebLinkAbout0810 Declaration ot Domicile and Citisenship ~8
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. WCIE COUNTY, FIORIDA: -
This is my de:laration of Oomicile and Gitizenship in the State of Florida thst 1 am filin~ this day in aooordancs and ~
in oonfo~mity with Chapter 222, Seceion 222.17, Florids Statutes.
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I was formerly a legal ~esident of
(CitY) (Stats)
and I resided at y . However 1 have chanqed my domidle
treet and Number) -
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to and am and have been a bona fide ~esident of the State of florida since day of
e~~~!~ ~ • 19~, a~d ~ I reside at ~
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(Straet snd Number)
FORT WERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my daclarotion of citizenship, actual iagal residenoe and domiale i~ the State of Horida.
(Insert here any pe~tinent facts, such as sale of propetty or business, or ~elinquishme~t of employment
at former domicile, removal of family to new domicilc, purchase of home, etc.)
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FILEO AND RECOROED
ST. Lt1C1E COUNTY. FLA.
~?F COR;^_. y~RIFIFp
1~~3887'
'69 OCt 6 10: 46 .
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E ~OG R r•OI :.S
~ CL~RK CIRCUIT COURT
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1 RIRTHER CfRTIFY that 1 will aomply wlth all other roquirernenn of a lepal reside~t of this Stote. ~
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;I~~~~~RRsCERTIFY that I have no intention to return to npy former"domicjle~ and I intend to remain in FORT [
PIERC~~?l~T,LUCI~zGOUNTY, FLORIDA, permanently. ~
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~~~Sworn to and subsuibed before me this day of ~C~~~~~ , 19~.
ROGER POITRAS
CLERK CIRCUR COU Notary Public
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By D.C. My Commisiwn expires ,
Qe b~ ~aevl~d in duplicata and ori~inal fil~d with Cl~eic Cira~if Court, asd duplicah wiN~ Tax AsMaor.)
. 13 600K~vO PACE ~08
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