HomeMy WebLinkAbout1416 Oeclaration oi Domicile and Citizenship ;
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filinc,~ this day in acoordance and
in co~formity with Chapter 222, Settion 222.17, Florida Statutes.
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I was formerly a legal resident of - . -
(City) (State)
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and I resided at ' However 1 have changed my domic.ile s
(Street and Number) }
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to and am and have been a bo~a fide resident of the State of Florida since ''Z`J day of
- - - . 19?~ , and I reside at ~O L~
(Street and Number)
fORT 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 fads, such as sale of properiy or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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FILED AND RECOROEO`
ST. LUC1~ COUNTY. FLA.
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'70 JA~! 26 AM Il: 09
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C~ERK C:?~~UIT COUR7=
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State. ~
I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~Swom.to and subu~ibed before me this day , 19 ~
ROGER POITRAS
K CtitCU1T COURT Notary Public
6 ~ D.C. My Commission expires
(To be ~xecuted in dupliut~ and oripinal fil~d wiN~ Clerk Circuit Couirt, snd duplicat~ with Tau Ass~s~or.)
aooK182 PAGE~4~.4
No. 13
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