HomeMy WebLinkAbout1211 D~claratio~ ot Oo~nicil• and Citi:~nshlp {
TO THE STATE AN~ ~OUNTY TAX ASSESSOR,
51. lUC1E ~OUNTY, FlOR10A: ~
This ~s my declaration of ~om~cile and Citizenship in the St~te of Florida that 1 am filinq this day in aocordance snd
~n conformiry w~~h Chapter 222, Section 242.17, Florids Ststutes.
I was fo~me~ly a legal ~esident of __~`'~'~-~"~_U----- -
~ (~ity) (Stah)
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and 1 ~esided at --~---~t
~ 0l0 ~ 1 Howevef 1 have chan~ed my domid~e
(Street snd Number)
to and am and hsve been a bona fide rasidsnt of the State of Florida since _ day of
- - - - - 19 and 1 reside at f ~ . , ~
(Street and Number)
FORT MERCE, SAIN? lUC1E COUNTY, RORtOA
and this stateme~t is to be taken as my declaration of citizenship, actuat legal residence and domicile in the 5tate of Horida.
(Ir?sert he~e any pertineni facts, such as sale of property or busineu, or relinquishment of employment
at former domicile, removal of family to new domicile, purchsse of home, etc.)
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f LEO AND AECOROEO .
i~. ~tiCiE COUIITY FIA. .
ItOCER POITRAS
CLERK C1RCUtT COURT
RECORD vER~F1E0~_
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~ I FURTHER CERTIFY that I will oomply with a1! other requiremenri of a Isqal resident of this State. ~
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' _~~URTHER CERTIFY that I have na intention to return to my former domicile, and I intend to remain i~ FORT ~
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PIERCF~;~~'1:UC)F~:COUNTY, FLORIDA, permanently.
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. CI_ (Name)
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x Sworn to and subscribed befae me this ~ day o '~'L`'`'~` , 19~~
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~ ROGER rO1TRAS
~ CIRCUR COtJRT Notary Pubtic
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~ By ~ D.C. My Commission expires
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~ Ro b~ ~x~cuhd ie dvplica~s and ori~i~+al Rl~d whh CIKk qrarif Cou~t, and duplieaN wilh Tax A~or.)
~ . 6UOK ~&9 P~~12C8
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~ ~ $ 4 i
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