HomeMy WebLinkAbout0264 Declaration~ ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
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Sl. LUCIE COUNTY, FIORIDA:
This is my decla~atio~ of Oomicile and Citizenship in the State of Florida that I am filing this day in accordance and
~n conformity with Chapte~ 222, Section 222.17~ F onde Statutes.
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I was formerl a 1 al resident of
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(Ciry) ~ (State)
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and 1 res"sded at ~ However I have changed my domitile j
(Street and Number) ~ _ ~
to and am and have been a bona fide resident of the State of Florida since day of ~
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_ , 19-~and 1 reside at
(Sfreet and Number)
FORT PIERCE, SAtNT LUCIE COUNTY, FLQRIDA
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and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Inse~t here any pertinent fads, such as sale of property or business, or relinquishme~t of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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FILEO hND RECOROED
;,T. LUCIE C4U~~TY. ~L~.
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'69 f!^~~ 17 PM 3: q.,-~ i
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CLFRK CIRCUIT COURT .
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1 FURTHER CERTIFY that I will aomply with all other requirements of a legal resident of this State.
1 FUR HER CERTIFY that I have no intention to return to my former domiule, and I intend to remain in FORT
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PIERCE, S,,1' ~jiE COUNTY, FLORIDA, permanently.
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Swom to and subscribed before me this day of . 19
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ROGER POITRAS
':y ~ CIRCUIT COURT Notary Public
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~ gy _ ~i D.C. My Commission expires
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(To bs executed in duplicate a~d ori~inal Rled with GKk G~cuit Couvt, snd dupliut~ with Tsx Ass~sso~.)
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