HomeMy WebLinkAbout0216 DeClaratio~ ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, F~oR~oA: 185"~1~ ~
This is my declaration of Domicile a~d Citizenship in the State of Flo~ida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal ?esident of _ .
" (Ciry) (State) 1
~
and 1 resided at __.L_Y ~~iy"L • However 1 have changed my domiti~e
(St~eet and Number)
y'1 _
to and am and have bee~ a bona fide resident of the State of Florida since _ day of
- _ - , 19~e~, and I reside at ~ 9 . ' ~
(Street and Number)
i
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residerxe and domicile in the State of Horida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
~ ~ ~ ) F~~EO ANO R ~
ST. LUCIE COUNTY. F~A:'
RECORD V~R~FIEO
. 185718
'69 NOV I1 aM 9: 51
s~
~U~ 'OITRAS
- CL_~RK CIRCUIT COURT;
II
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1 RIRTHER 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 m mer domi le, a I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently.
- (Name)
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= (Address)
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• 5wo~~t~to ~i'+~subscribed before me this I x day of ~ , 19~~.
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~ • ' . : R'OGeR ~~PO~TRAS
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~ CIRCUIT COURT Notary Public
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~ 8y D.C. My Commission expires
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(To b~ ~xecu»d in duplluh snd originsl ~il~d with CIKk Grcuit Court, and duplicah with Tax Ass~or.)
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~ 600K 1v1 PACE ~16 `
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