HomeMy WebLinkAbout0117 Deciaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapte~ 222, Section 222.17, Florida Statutes.
_
I was fo~merly a legal resident of :
~ (City) (State) i
f
~.2~~ • a~?~-~~~ . Nowever I have chan ed m domiCi~e
and I resided a! - - - - - 9 Y
(Street a Number)
to and am and have been a bona fide resident of the State of Florida since day of t
- - - 19- and I reside at _ ~ `
~ . ~ (Street and Number) ~
ensr e~~ee~e ew~~T Illf IC f AItN*v c~np~nw
- = x~! ' '_r_ 7r~er.. ,
and this statement is to be taken as my declaration 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.)
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FILEO ;.ND RECORDED
ST. LUCIE COUPJTY, FLA.
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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 1 have no intention to return to my former domicjle, and I intend to ~emain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_
~ • - ~
~
, (Name ~
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!/~UfC.R~sL i6! Q~i,CLCj~
~ (Address)
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~ Swom to~and subscribed before me this ~ day o 19-~'=•
~
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~ ROGER POITRAS
~ K CIRCUIT OURT Notary Public
C~
~ gy D.C. My Commission expires
~
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(To be sxecuted in dupliuts and originsl filed with Clerk Circuit Courf, and duplicate with Tax Ass~s~or.) '
~ ~ k 1~~ PAr,E 117
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