HomeMy WebLinkAbout0137 Declaration ot Dornicile and Citizenship
TO THE STATE AND COUNYY TAX ASSESSOR. 1856'7~3
51. IUCIE COUNTY, FLORIDA: '
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This is my declaration of Domicile and Citizenship in the State uf Florida that I am fili~g this daXyi~ acco~dance and ,
in conformity with Chapter 222, Sectio~ 222.17, Florida Statutes. `
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I was formerly a legal ~esident of P'~'~
(Ci - - - - - (State)
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and I res~ded at _~3!~ ~'~%~?'-~~~~~•t.t,./ However I have changed my domiti~e
(Street and Number)
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to and am and have been a bona fide rasident of the State of Florida since _____._-_.T day of
6 ~ ~ r - ~ l ~7~G~
. 1l-1_, anr I es re a ~
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in ihe State of Horida.
(Insert here any pertinent facts, such as sale of property or business, or ~elinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.) ~
fIIED ~~1D RECOROEO
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s: r. ~~OITRt.S
CL~RK CIRCUIT COURT
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~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my fo er domiG~e, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ D ,v ND wA,~
~ (Name)
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Swom to and subscribed before me this ~ ~ day of / , 19-L.
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: ROCsER POITRAS
: CLERK CIRCUIT COURT Notary Public
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~ By D.C. My Commission expires
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~ (To be sxecuted in duplicate and original ~iled with Clerk Gnuit Court, and duplicate with Tax Ass~stor.) '
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