HomeMy WebLinkAbout0486 v~
Oectaration ot Domicite and Cit~zenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~(1~ J ;
51. WCIE COUNTY, FLORI~A: V~ '
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This is my declaration of Domicile and Citizenship in the State of Florida that i am filing this day in accordance and i
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,n conformity with Chapter ?22, Section 222.17, Florida Statutes. €
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I was formerly a legal resident of - `
(Ciry) (State)
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and I resided at _ However I have changed my domiCile ;
(Street and Number)
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io and am and have been a bona fide resident of the State of Florida since ?D _ day of '
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- L , 19~Q , and I reside at 1~~J' 2- l~1P~2x ~4Gj~~~
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FORT PIERCE, SAfNT LUCIE COUNTY, FLORIDA
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 pert~nent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.) ~
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FICED AkD RECOR~EO
ST. ~UCIE COUNTY fLA.
ROCER POITRAS
~lERK C~RCWt COUR ~,R
RECOR~ YEP.IFIEO`~.~. D
fEe 11 t 14 PM'71
2(14 if;2
! FURTNER CERTIFY that 1 will comply with all other requirements of a legal resident of this Siate.
I FURTHER CERTIFY fhat I have no intention to return to my former domiv~e, and ! intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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(Name)~ 2- ~1~1C 2 7' ~ 2 /4
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Addr ss
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Swom to and subscribed before me this day of , ~q
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, ~ ~OGER~~OiT1tA5
_ 'r .-CCERK C~1RCU1T COURT Notary Public
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SY. ~ _ D.C. My Commission expires
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'~(1'? ~~xecuted in duplicata snd oriqinal tiled with Clerlc Grcuit Court, snd duplicate with Tax Ass~ssor.) ~
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