HomeMy WebLinkAbout0127 De~laration ot Donti~ile and Citizenship ~
TO THE STATE AND COUNTY TAX ASSESSOR,
Sj. WCIE COUNTY, FLORIDA:
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This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and ~
~n conformity with Chapter 222, Section 222.17, Florida Statutes. ~
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1 was formerly a legal resident of -
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and I resided at _ _ _ _ - ~ _ _ _ However 1 have changed my domiCile ;
(Street and Number) ~ I
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to and am and have been a bona fide resident of the State of Florida since day of
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L~C.!',-2-~1~1~:.. G~Z~i/ ~r ~-sc. - aL//t'' -
~ ~ (Street and Number)
FORT PIERCE, SAINT WCIE COUNTY, FLORIDA ~ 4'<~~ : ~,.,;(o?~C-rs`~
and this statement is to be taken as my declaration of :itizenship, actuaGiegal residence and domicile in the State of Florida.
(Insert here any pettinent fads, such as sale of properry or business, or relinquishment of employment
at former domicile, remova( of family to new domicile, purchase of home, etc.)
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. FILED AND RECORDED ;
S ~lfC1E COUNTY. FL~. '
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I FURTHER CERTIFY that I wil) comply with all other requirements of a legal resident of this State.
~ I FURTHER CERTIFY that 1 have ~o intention to ~eturn to my former domitile, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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Sworn'to and subscribed before me this ~ day ~ , 19~~
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~ ROGER POITRAS
~ LERK CIRCU T COURT Notary Public
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~ By ~ ~ D.C. My Commission expires
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(To be executed in duplicste snd original ~iled with Clerk Circuif Couet, and dupliute witl~ Tax Assessor.)
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~y ~ k 1~2 ~27
aacK Pnr,E
No. 19
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