HomeMy WebLinkAbout0122 Qeclaration ot Don~icile a~d Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR,
Si. LUCIE COUNTY. FIORIDA:
This is my declaration of Oomicile and Citizenship in the State of Florida that I am filing this day in acco~dance a~d ~
in conformify with Chapter 222, Section 222.17, Florida Statutes. ~
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I was formerly a legal resident of
~C;ty) (State)
and I resided at S~~_ al~ ~r - ~ However 1 have changed my domitile
(Street and Number)
to a~d am and have been a bona fide ~esident of the State of Florida since day of
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- - - - - ~ 9 and ~ r ~cao a~ Q ~~`-e^ _
(Street and Number)
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fORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal ~esidence and domicile in the State of Florida. .
(Insert here any pertinent fads, such as sale of property or business, or ~elinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
--'~w~t~.-, ~ ~ ~ Lc •
~ FIL
EO AND RECORDEO
S7• L.UCtE COUNTY. F~q,
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'70 JAN 5 ~y ~Q ; 5s ~J
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~LERK CIRCUIT COURT'
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i FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State. ~
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1 FURTHER CERTIFY that I have no intention to return to my former domic,ile, and 1 intend to remain in FORT i
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PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_
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~ . ~.~~s,c.~ ~G'L~LGfk-c' L- -K~'L
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Sworn to .and subxribed before me this ~ day ot , 19~.(~ #
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ROGER POITRAS
~ CLERK CIRCUIT COURT Notary Public
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~ gy ~ D.C. My Commission expires ;
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(To be sxecuted in dupliuts and originsl ~ilsd with Gerlc Circuit Cour~, and duplicat~ with Tax Ass~ssor.)
~ ~ R ~8~ PACE 1~~
BOOK
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