HomeMy WebLinkAbout2185 Declaration ot Domicile and Citizer~ship
TO TNE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FIORIL~A: ~
This ~s my declaration of ~om~ale and Citize~ship in the State of Florida that 1 am filing this day in accordance and
~n conform~ty w~th Chapte~ 222, Scction ?22.17, Florida Statutes.
t was formerly a legal resident of Big Spring Texas
(City) (State)
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and 1 resided at 260b 1{y?21ri St2'@@t However 1 have changed my domic,i~e t
(Street and Number) {
to and am and have been a bona fide resident of the State ~f Florida since 12 th day of
OCtObeT , ~9 , and I reside at _ 471 Zacero _
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
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 pe~tinent facts, such as sale of property or business, or relinqu~shment of employment
at former domicile, remov~l of family to new domicile, purchase of hame, etc.)
Entering Dale in the 2nd grade.
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FILED~ AND RECOROED~~ ~
ST, IUCIE COUNTY. FLA.} !
RECORD VERlF'EO
1~~85~
'TO OCT 19 PN 3: 16 ,~~p ~
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F~O~En r01TRAS
CLERK CtRCUIT COURT~
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~ I FURTHER CERTIFY that I will comply with all other requirerr~ents of a legal resident of this State.
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I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FOR7
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~ PIERCE, SA4~VT •1.~1CIE COUNTY, FLORIDA, permanently. a
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~ i~; E 3,rpt (Name) ~rs ;
~ = ~r~ ~ ~ = doan ldlf~lt~ffid ~ierrifield ( Dale
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~ • Sworn to and subscribed before me this ____1 t~ aCOtbeT 70
day of - , 19--.
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F:
~ ROGER POITRAS -
~ K CIRCUIT COURT Notary Public
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~ ~y x`'~"C~ ~ D.C. My Ccmmission expires
Ro b~ ~x~cvt~d in dupliut~ and oripinal ~il~d with Cl~rk Circuit Court, and dupliut~ with Tax Ass~ssor.)
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