HomeMy WebLinkAbout0121 ~ Declaratio~ of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~
Sl. lUC1E COUNTY, FLORIDA:
lhis is my declaration of Uomicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
1 . • i~~-Cv
1 was formerly a lega) resident of _ -
^ ~~~ty) (State)
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and 1 resided at ___~f~~=!~__~~~` However I havechanged my domicjle ~
(Street and Number) ~ i
to and am and have been a bona fide resident of the State of Florida since day of :
i•l~~~6 ~~,r,6~ _ , - - ~"~a~esid~~ _ ~9:"-,
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of propP~ ~_::^~~s, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase bf home, etc.)
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FI~ED ANp ~
ST, ~V~~E C~ ECOROEO i
-,.~~Rn ~ U tTY ~lA. !
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~31
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COURr
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1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
1 FURTHER CERTIFY that 1 have no intenfion to return to my former domic,ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, ~LO~:~Jl~, ~:manently.
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_ ' ' ~ (Name)
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_ (Address)
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Sworn to and subscribed before me this ~ day of , 19 -
ROGER POITRAS
C CIRCUIT CO~ Notary Public
gy D.C. My Commission expires
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(To be exxuted in duplica~e snd originsl ~iled with Clerk Grcuit Court, snd dupliuts with Tax Assessor.) t
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~ n a 1$~ pAGE ~~1
~ , ~ 800K
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