HomeMy WebLinkAbout2867 Decla~ation of Domicile and Cifisenship
TO THE STATE AND GOUNTY TAX ASSESSOR, ~ r(~O
Sl. IUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in actordance and
in conformity with Chapter 222, 5ection 222.17, Florida Statutes.
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I was formerly a tegal resident of _
(~iry) (State)
and I ~esided at --~~~D cL~ However 1 have changed my domivle
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since day of
~E~!e~ 19~ ~ and 1 reside at ~it«.tt TT~~ o73D ~Oti-~~J~~~{~~
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my detlaration of citizenship, actual legal residence and domicile in the State of Ho~ida.
(Insert 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 AND RECORDEO
ST. LUCIE COUN7Y. FLA.
~.~R^ V~RI~•.FO
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'69 DEC 3 I AM 10 ~ 2 0
.:,~rr- ~0'TR~S
CIERK CIRCUIT COURT
I FURTHER CERTIFY that 1 wiU comply w;th al! other requiremenis of a legal resi~ent of this State.
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i I FURTHER CERTIFY that I have no intention to retum to my former domic.ile, and 1 inte~d to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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( me)
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(Address)
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Sworn to e~d subscribed before me ihis day of ,~q~~ T
!l~LL ~~i~y~ F
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R06ER P0ITRAS'•..
. CIRCUR COURT Notary Public
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gY , D.C. My Commission expires
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(To b~ ~xecuhd in dupliuM and original filed with Gerlc Grcuit Court, and duplicat~ with Tax Ass~ssor.y
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