HomeMy WebLinkAbout1068 Declaratio~ ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, -
Sl. IUCIE COUNTY, FLORIOA:
This is my declara~ion of Domicile and Citizenship in the State of Florida that I am filing this day in acoordancs a~d ~
~n confo~mity with Chapter 222, Section 22?.17, Florida Statutes. '
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1 was formerly a tegal resident of
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and I resided at ~ . Howeve~ I hsve che ed m domi '!a
r19 y G ~
(Street a Number)
to and am and have been a bona fide ~esident of the State af Florida since day of
19~ and 1 reside at ~~U - ~~~`L'i~
. .
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my deciarotion of citizenship, actual tegal residence and domicile in the S~late of Florida.
(lnsert here any pertinent fads, such as sale of property or busineu, or relinquishment of employment ?
at former domicite, removal of family to new domicile, purchase of home, etc.)
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- Ftl.EO ~P1D RECORDEO
~T. LUCtE CJU~~TY. FLA.
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Cl.~h~ ~~~<CUfT ~OURT
I FURTHER CERTIFY that I will o~mply with a(I other requirements of a legal'resident of thia State.
I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SA~IV~~,CIlCI~'CO~INTY;. FLORIDA, permanenily.
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~ ' ~ (Name)
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Sworn to and-sulisuibed befo~e me this ~ day of ,~q
ROGER POI?R.AS ~
IERK CIRCUIT COURT Notary Public
BY ~~u~ D.C. My Commiuion expires
(To be executed in duplicats and or+ginsl filad with Gerk C'irwi! Court, snd duplicsts with Tax Asssssor.) -
gooK1~3 Pa~106?
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