HomeMy WebLinkAbout0156 . ~
Decl~ration ot Domici~a and Citizenship ~ '
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida-that I am filing ihis day in eccordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a fegat resident of [Y~~`~- _ _
/ (City) ate)
and I ~esided at 7cL.d_ q 1rc-Y U_.~' However 1 have changed my domitile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ~-.~1 day of
- - 19~1~, and I reside at _______~+2Q !'1'----
r
_ `,d / o ~ r ~ v ~ I ~ (Stree nd Numbar)
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FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA 3 4~~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Irt3ert here any pertinent facts, such as sale of property o~ business, or ~elinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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3T.ROQEAa~ Mc~Afl~
RECOA RK ~IRCUIT
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~ 1 FURTHER CERTIFY that I will oomply with 311 other requirements of a leya) resident of this State.
~ I FURTHER CERTI"rY that I have no intention to return to my former domicjle, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ (Name) ! a h.~ M
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` ddress) I~u r~ ~ C t~- ~/.;Y i~ e
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~ Swom to and subscribed before me this ~ay of 19 .
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~ ROGER POlTRAS ~.~`~,~Z ~ ~ . ~.t-/•..~~ f~
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~ CLERK CIRCUIT COURT ~`~~G~~:' d'~`- ' '
; 4, f~,;-;~r,~d'~ otary Public
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q BY i~~, .j~rtission expir ~
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` Ro b~ ~x~cut~d in dvpliut~ and oripinal Rr , A~?
~ ~'~~~rnuru~me~~~ Court, and duplieat~ with Tax Ass~ssor.)
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