HomeMy WebLinkAbout0123 Declaration ot DomiCile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
SI. IUCiE COUNTY, FLORIOA:
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 Chapter 222, Section 222.17, Florida Statbtes.
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I was formerly a legal resident of -~G~~-- ~G~ r
(C~ty) (State)
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and I resided at f~J However 1 have changed my domitile
(Street and Number) ~
to and am and have been a bona fide resident of the State of Florida since day of
L 19 ~ and 1 reside at /~O~'S
(St eet an um r
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PORT 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 property or business, or relinquishment of employment
at former domicile, removal of famify to new domicile, purchase of home, etc.)
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F~LEO
S;, ~V AND RE~
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R~ED'
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I FURTHER CERTIFY that I will comply with all other requirements of a legat resident of this State.
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I FURTHER CERTIFY that I have no intention to return to my former domiGle, and I intend to remain in FORT
PIERCE, SAINT,LUC{E_CqUNTY, FLORIDA, permanently.
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~ ~ (Name)
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Sworn to and subscribed before me this ~ day of , 19
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ROGER VOITRAS
tERK CIRCUIT COURT Notary Public
~ By /LZ'{`!'-~~ D.C. My Commission expires
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(To be executed in dupliute and original filed with Clerk Grcuit Court, and duplicats with Tax Assessor.)
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