HomeMy WebLinkAbout1454 O~cla~atlon ot Domlail~ and Citis~~ship
TO THE STATE AN~ COUNTY TAX ASSESSOR, ~nt~l~
51. IUCIE COUNTY. FlORIOA~
This is my dectaratio~ of Oomicile and Citisenship in th~ State of Florida that 1 am filinq thi: day in aooo~d~nos and
~n conformity with Chapter 222, Sectio~ 222.17. Florida Statutes.
I was forme~ly a legal ~esident of ~~c~c..%cl -
(City) (Stats)
and I resided at ~~3 ~~,~4~~~ ~ Howevar I have chanped my domitile
(St~eet and Number)
to and am and have been a bona fide resident of the State of Florida since day of
,~~'D , n,~
. 19_~', and I ~eside at ~w ~~w~a.t_~~ ~Xh
' (Street sntl 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 Ho~ida.
(Insert here any pe~tinent facts, such as sale of property or busineu, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, ett.)
l~~,G~L~l~
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FIlEO ANO RECOROEfl_ _
ST.lUC1E COUNTY flA. ~
ROCER POITRAS
CLERK CIRCUIT C411RT
RECORD YERIFIED
J~ I~I 12 ss PH'~I
- 203316
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~ I FURTHER CERTIFY thst I will oomply with al) other requirements of a Ispal residsnt of this State.
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I FURTHER CERTlFY that I have no intention to return to my former domitjle, and I intend to remain in FORT
~
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, pe~manently.
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~ .~~t#+ib a~~~tbsd before me this day of , 19~
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~ :'~o~s~t ~rom~~ -
~ : ~ :~K ~lRCUIr tOtlRt' Notary Public
~ aY I D.C. My Commission expires
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~ Ro b~' Jn duplicat~ and ori~inal fil~d wilb CINk Cir~A~lf Gwf, a~i Jupli~at~ with Tax At~.)
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