HomeMy WebLinkAbout0700 Deciaration ot Domicile and Citise~ship
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TO THE STATE AND COUNTY TAX ASSESSOR,
51, IUCIE COUNTY, FLORIDA:
This is m declaration of ~omicile and Citizenshi in the Sfate of Florida thst 1 am filing this day in aooordance and ~
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in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of V e$~~) _ -1 y'
(City) (State)
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and I resided at C Fbwever I have changed my domiti~e ~
(Street and Numbe~) s
to and am and have been a bona fide resident of the State of Florida since ~~'.Q day of
~~.c~ed~ , 19~ 9, and I reside at C/~~ lG~ tJ ~P •
(Street and Number)
FOltT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual lega) residence and domicile in the State of Horida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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I F1LE0 AND RECOROED'
~ ST, IUCIE COUN7Y. FLA.
' RECORf `~FRtF1ED
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~ '70 JAN 13 PM 3:23
~ Rect_~z ?~oi7RaS
~ CLERK CIRCUIT COURT'
~ I FURTHER G'HtTIFY that I will comply with al) ether requirements of a legal resident of this State.
~ 1 FURTHER CERTIFY that ( have no intention to return to my former domiGle, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ Ma"^~~
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~ D r ¢ P e
_ (Address)
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~ ``~tL~~~•~I~ttttt~, . .
~ Swom to and subsc~ibed before me this day of j~. _
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~ ROGER POITRAS N ~ ~ _ -
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CLERK CIRCUIT COURT Notary Public : : ~ •
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y: ;g~•~•.~.v~fl~`~;s=' ;
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~ By D.C. My Commission expires
~ ~„1,
~ 1- I 7 - 't ~ ~ -
~ (To b~ ~x~cuhd ie duplicab and ori9inal filsd witl~ CIKk Circuit Court, snd duplieafr with Tax A~~~xa
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~ 1~~ b98
~ No. 13
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