HomeMy WebLinkAbout2862 Declaratio~ ot Domicile a~d Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and ~itizenship in the State of Flo~ida that 1 am filint~ this day in accordante bnd
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of
~C~ty~ . (State)
and I resided at _ ~ ~ ~Q~ ~Wever 1 have changed my domiti~e
(Street and Number) ~ ;
to and am and have been a bona fide resident of the State of Florida since day of ~
19~ and I reside at
--F~ - ~ .
( Num )
CC~~~-~~
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my decljration of citizenship, actual legal residence and domicile in the State of Horida. ~
(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.)
~GG.a:~JE.t.~~•
FILED ANO RECORD
ST~ UCtE COUNTy
cRIFIEG
'69 OEC 31 ~ 9 : S
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f?o.:e~ ~ R.~s ~
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ERK C1RCUiT COURr ;
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I FURTHER 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 my former domicjle, and I intend to remain in FORT
PIERCE, $Ia1NI lUC1~~,~0UNTY, FLORIDA, permanently.
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Sworn to and subscribed before me this day of . 19 `
~
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, ;
~ ROGER POITRAS _
C CIRCUIT COU T Notary Public ~
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~ g D.C. My Commission expires
Y
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~ (To b~ executed in dupliate and original filed with Clerk Grcuit Court, and dupliut~ with Tsx Ass~sto?.)
~3 BOOK 18~ PACE ~~62
~.p
No. 13
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