HomeMy WebLinkAbout2653 Deciaration ot Do~nicile and Citisenship
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TO THE STATE AND COUNTY TAX ASSESSOR,
51. IUCtE COUNTY, FIORIDA: ~
This is my deciaration of Domicile and ~itizenship in the State of Florida that I am filing this day in aaordante and
in conformity with Chapter 222, Section 224.17. Florida Statutes.
t was formerly a legal resident of _ _
~C~~y~ (Stats) ~
and 1 ~esided at - o?O ~v ~ n - However I have changed my domic~le ~
(Street and Number)
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ru a~d am and have been a bona fide resident of the State of Florida since - day of
_ ,~~1[.(~yj~..G._ , 19~~, and I reside at "7 ~ G
(Street and Numbe~)
FORT PIERCE, SAINT LUCIE COUNTY, ROitIDA
and this statement is to be iaken as my declaration of citizenship, adual legal residence and domicile in the State of Horida.
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(Insert here any pe~tinent facts, such as sale of property or business, or relinquishment of employment t
at former domicile, removal of family to new domicile, purchase of home, etc.)
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EILED aa,D RECORDEO
sT. L!~CiE COUNTY, FLa.
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~ C~ERK GtRCI:i + COURT ;
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~ I FURTHER CE~tTIFY that 1 will oomply wiffi all other requirements of a legal resident of this State.
~ RTHER CERTIFY that I have no intention to return to m former domicjle, and I intend to remain in FORT
~ 1 FU Y ~
~ PIERrE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~ ~ ,
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~ • - - ~ (Name)
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Sworr* to ai~d subscribed before me this 7 day of . 19~.~-
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~ , , ROI~ER POITRAS
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~ CIRCUIT GOURT Notary Public '
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M~ By ~ D.C. My Commission expires
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- (To b~ ~xecvhd in duplicat~ and oripinal fil~d with Cl~rk Circuit Cour~, and dupl~cat~ with Tu Ast~ssor.)
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