HomeMy WebLinkAbout0549 ~
Declaration ot Dor~icile and Citizenship {
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. WCIE COUNTY, FIORIDA: ~
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This is my decla~ation of Domicile and Citizenship in the State of Florida that I am filing this day in eooo~danoe and
in conformity with Chapte~ 222, Section 222.17, Florida Statutes.
1 was forme~ly a legal resident of
( fY) (Staro)
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and 1 ~esided at Gt ~ °r 0--- However I have changed my domicile
(Street and Nu er)
ro and am and have been a bona fide resident of the State of Florida since - day of
, 19.~e~, and 1 resida at ~ ~ a7n'~ -e ~ °L+~J-1-t'"°-e"~
(Street and Number)
FORT MERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declarotion of citizenship, actual legal residence and domicile in the Stab of Horida.
(Insert here any pertinent fads, such as sale of property or busineu, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of horrk, etc.)
F~lEO AND RECORDED
~ S~. Ll1CtE COUNTY, F~h
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I FURTHER GERTIFY that I will comply with all other requirements of a legal resident of thia State.
I FURTHER CERTIFY that I have no intention to return to my former omi4 , and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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. _ (Name) ~-G- S 7" NF
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'Swom'to e~d sub~uibed before me this ~ day of , 19~~
ROGER POITRAS
CIRCUR COURT Notary Public
By D.C. My Commission expires
lTo b~ ~x~cuhd in duplicab and oriyinal fil~d witF~ Gerlc Cirwit Courf, and dupli~at~ wkb Tax Assa~or.)
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