HomeMy WebLinkAbout1428 Declaration ot Domicile and Citlzenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~
~
Si. LUCIE COUNTY, FLORIDA:
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 Statutes.
I was formerly a legal resident of - ~~'~~E~~"'a~l~i~ _ `a'd~/a _
(City) (State)
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and 1 resided at However 1 have changed my domicjle
(Street and Number) ~
ro and am and have been a bona fide resident of the State of Florida since day of
, 19~~, and I reside at °2v a~ '~~~~~~~d
(Str and Number)
FORT PIERCE, SAlNT LUCIE COUNTY, FLORIDA '
and this statement is to be taken as my detlaration of citizenship, actual legat residence and domicite in the State of Horida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishme~t of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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FIlEO AND RECORDED ° ;
ST. I.UC~E COUNTY~ FLA. -
i<.:.^OR'•~ '"~t~ ~~SB~~G 3
'70 JA1~ 26 PM 2 :30
j ;to;,_: ~ ~t ~ ~:.s .
CLERK CiRCU1T COURT:
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State. t
I FURTHER CERTIFY that I have no intention to return to my former domic.ile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
iG,~~, „
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- . ~ (Name) ' .
- - - . , = .~~.~R~! G ~~.f~ SsE~
, ; ~
. - . (Ad~lress)
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Sworn ~to and subscribed before me ihis °'2 ~ day of , 19~ }
~
ROGER POITRAS ~
K CIRCUIT COURT Notary Public ~
B ~ D.C. My Commission expi~es
(To be executed in dupliute and ori~inal filed with Clerk Circuit Courf, snd dupliat~ with T~x /4s~ssor.)
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