HomeMy WebLinkAbout0296 Declaration ot Domicile and Citlzenship
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FlOR10A: -
This is my decla~ation of Uomicile and Citizenship in the State of Florida that 1 am filing this day in aocordante and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
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1 was formerly a legal resident of _ ~Q'~~
(City) (State)
and 1 resided at L~~~_~• ~~X a~ However I hsve changed my domiCile
(Street and Number)
'q,~,
to and am and havs been a bona fide resident of the State of Florida si~ce ~ day of
, 19
6 L, and 1 reside at D D ./~d'• , O•
(Street and Nu er)
FORT PIERCE, SAINT LUCIE COUNTY. FLORIDA
and this staternent is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Ho~ida.
(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.)
FILED AND ~RECORDEp- ;
C~~=~-w l~ ~ ~y ST• LUCIE COUNTY~ FLA.
4 ~ co~r ~~Er~~FiEo
-~85'?"?'4
'~9 NOV 18 AM 9: 15/
~'I'14 Q,~.~/
ROGER POlTRA$
CL£RK CIRCUIT COURT
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1 FURTHER CERTIFY that I will oomply with all other requirements of a(egal resident of this State. !
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I FURTHER CERTIFY that 1 have no intention to retum to rny former domiCile, and I i~tend to remain in FORT ?
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PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. j
~ ~ (Name)
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~ (Address)
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~ Swotn to and ~utiscribed before me this ~ da of , 19~.
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' :CZRCt1~''.~CURT Notary Public
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~ By D.C. My Gommission expires ~ '
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~ Ro b~ ~xecuted in dupliute and ori~inal filed with Clerk Circuil Court, and dupliul~ with Tax As~or.)
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