HomeMy WebLinkAbout0416 peclaratian ot Domicile and Citize~ship
TO TNE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FLORI~A
This is my declaration of Dom~cile and Citizenship in the State of Florida that I am filing this day in accordance and
~n conformity with Chapter 2~2, Section 222.17, Florida Statutes.
1 was formerly a legal residenr of Hagersto~ru ~
~C;N~ (State) ~
Route 1 `
and 1 resided at _ However 1 have changed my domic,ile
(St~eet and Number?
!o and am and have been a bona fide resident of the State of Florida since Septe~ber 1Z day of
, 19_.70 , and I ~eside at Blnetield ~iry.- - - ~
(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 facts, such as sale of property or business, or relinquishment of employrreent
at former domicile, remova! of family to new domicile, purchase of home, etc.)
John. Da~id. Helen, Perry dc Mnette Gaver
' F~L~O~AND' R~~p~p~0~
ST. ~UCIE COUN1'Y; F~~A;~
RECORD VERIF?ED
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'T0 SEP 21 JW 10: ~2
ROGER POITRAS
CLERK CIRCUIT COURTJ
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I FURTHER CERTIFY thai 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 domiG~e, and I intend to remain in FORT
a~ERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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s. ~}bscribed before m~ this 21_,_-- day of 3EpL~h~- i9~Q_.
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~ ~ ~ ~08~'1~1TRAS
C~k~~CIRCUIT COURT Notary Public
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gY ~ - -L--- ' - U•C. My Commission expires .
(To b~ ~x~e~f~d in dugliut~ and ori~inal fil~d with Cl~rk Cinuit Couef, and dupliut~ with T~x Ass~s~or.) ~
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