HomeMy WebLinkAbout1570 .t:~': ~~1 '
o~luatlo~ 01 Domlafl~ aed CINsMShip
TO TNE STATE AND COUNTY TAX I~~SSESSt~R,
Sl. llJC1E COUNTY. FlOR10A: .
This ts my d~claratio~ of Oomicil~ ~nd Gtis~nsl+tp in tht Stah of Florida that 1 am fili~q this day in aooord~na a~d
in tonformity with Chapt~r 242. S~ttio~ 422.17, Florida Statuhs. . .
`~:.eG~d. ,
1 was form~rly a Ipal ~esid~+t of ~
tCih?) (S~at~)
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end 1 rosided ~t ~ . HowwK I have tharq~t~ my domWl~
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ro and am and have b~sn a bo~?s fid~ nsident of the Stat~ of Florida sinae -~=l~-~- d+y o~f
- , 19~~, and 1 n~WW~ at ~ ~ /i
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(Stre~t snd umb~r)
~ORT ~CE, SAINT LtlCti COUNTY, lLORIDA '
and this statemsnt ia to be taken as my dedsration of citi~snship, actusl le~al residenoe and domkil~ in th~ Stsfa of Horida.
qnaert here any perttnent fact:, such s: sale of property or business, or rolinqulshm~nt of employm~nt -
st former domicile, removal of family b new domicile, purchase of hon~e, NcJ -
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~ fIL-~EO'AND~ RE~C~~ ~
- ~ ~ S7. LUCIE CQWI~TY;~~~
aECORD VERIRiED ~ _ ~
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'~0 Ikt~ 2 i PM !2 : 26
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' ROGER POiTRA ~
; CL6RK CIRCUIT COURT~
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. 1 FURTHER C6tTIFY that I will oomply wNh all a~ nc~rtr~~ts of s te~ai raldent of thb Stah.
1 FURTHER CERTIFY that I have no intention to return b my former domic~le, and I intend to remain in FORT
PIERCE. SAlNT WCIE COUWTY,=FLORIDA, permanently. . _
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;~~~;~t7,~-.Sworn.~o ~d wbsaibsd before n~ this dsy of 19~d
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• O.C. My c,ommissf«+ .xpl~
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~iiii+w.i M d~iisar. a~! .ei~M.l AI.~ wi~b Cl..k ~w~it cw~1, awi ~lia~1. wMb. tmc II~....rJ
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