HomeMy WebLinkAbout1015 . r ~
Dtclaratio~ ot Domiail• a~d Citiz~nship 2U3~t~~,
TO THE STATE AND ~O'JNTY TAX ASSESSOR, .
Sl. IUCIE COUNTY, FLORIOA:
This is my declarstio~ of ~omicile and Citisenship in ths Stats of Florida th~t 1~m filin9 this day in aooo~d~nu a~d
~n conform~ty with Chapter 222, Sectiws 222.1?, Florida Statutes.
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1 was forme~ly a leflal rosident of -
(~ity (Stats)
and 1 resided at _~_L~- ---~~lJ• However 1 have ch~n~sd my domiCile
(Street and Numbe~?
to and am and have bee~ a bona fide reside~t of the Stats of Florids since c~2 day of
- - - 19~11, and ! reside a~ ,Z~~ ~ ~C~QL---~1/~~~i~/ `l~~i _
(Sheet and Number)
FORT N~CE, SAINT LUCIE COUNTY, RORIOA
and this statement _is to be taken as my declaration of citizenship, actual la9al residence and domicile in tFie State of Ho~ida.
(Insert here any pertinent facts, such as salc of property or busineu, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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CIE COYpTr ~
AOCER POITRA
IlEC01t01K?ERl~F ED
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~ 1 FURTHER CE~tTIFY that 1 will aomply with af) other requiremenb of a leyal resident of this State.
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! FURTHER CERTIFY that I have ~o intention to return to my forme~ domirjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently.
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H C~orT? t~f'~~subscribed before me this day of , 19~.
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~ ROGER r41TRAf
~ CLERK GRCUR COURT Notsry Public
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~ By D.C. My ~ommission expires
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(To b~ ~x~cvlad fe dupticaM and ori~inal Hl~d will~ Cl~eic Grwl! Cou~f, and duplieat~ wi~h Tax Aara~or.)
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