HomeMy WebLinkAbout0506 Declaration ot DomiCile and Citizenship
2(~~~-~~
TO iHE SiATE AND COUNTY TAX ASSESSOR,
51. IUCIE COUNTY, FIORIDA
ih~s is my declaration of Domicile and Cit~2enship in the State of Florida that I am fil~ng this day in accordance and
~ 1
~n canformity with Chapter 222, SecriQn ?22.17, Florida Statutes ~
I was formerly a legai resident of ~~~E~ {~~t- ~ F ~~~~/`~~/S
(City) (Sfate)
i
and 1 resided at ~~a ~~p ~./~L _S T~ ~Eo/~C -F. Q/~' However 1 have changed my domi~ile ~
(Street and Number? ~
^ ~
+v and an, ar.d have been a bona fide resident of the State of Florida since C~G ~L~a~ ~(~T~` day of ~
, 19.7J , and 1 r~side at ~ / ~ ~~~'~?1?_1_ ~1_Q__ ~
~
(Street and Number)
FORT PIERCE, SAfNT lUC1E COUNTY, FLORIDA
and th~s statement :s to be taken ~s my declaration of c~tizenship, actual legal reside~xe and domicile in the State of Fiorida. ~
~
(Insert here any pert~nent facts, such as sale of property or business, or relinquishment of employment ~
at fo~?ner domicile, removal of family to new domicile, purchase of home, etc,) ;
t
/7~jC.~L ~r /N v ,`o , ` ~a ~ C S'T~~g v ~-~z~,~~, ~
T/v ~L
2O~~~ i 3 t
FILEO ~y~ !'ECOR EO
fT, IUC+~ C~UNTY ~lA.
ROC[ry f'~ITRAS
CIERR C?RLUIF COURT
RECORD VE~?F1E0....--~--~
fE0 ~Z 2 19 ~'T ~ ~
~c°'~
~ ~
i FURTHER CERTIFY that 1_ will comply with al! other requirements of a legal resident of this State.
s
I FURTHER CERTIFY that I have no intention to return to my former domic,i(e, and I intend to remain in FORT
F PlERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
f
_ . % ~t~
'~c~-~'~-~ ~'j ~
• : (Nam ~ c/ ~
. . ~-C c.,- - ~ ~ ~r~IL~i`t- t~ i
~
~ ~ , ~ ~_t.? . 'S''? ~t% ~~%~virrr .zi o.?`.B
. ` (Address) ~
i ,
Swom to and subscnbed before me this _ °_v day of ~~'a?,~~'1!L~ _ _ ~q~/.
/i~ ~
ROGER POlTRAS .
- - L/ - ~
- ~
~ K CIRCUIT COURT Notary Public ~
~ ~-~i.~--f~- ~4L.~L-Ct - ~
~Y - _ - - - _ D.C. My Commission expires - -
4
(To b~ ~x~cut~d i~ duplicat~ and oripinal ~il~d with Cl~rlc G~cuit Court, and duplicat~ with Tax Ass~ssor.)
,3 ~~~K1~3U 50~
r "
. _ - - ~ ~
. , =St _ -r.,.-_. . .ti.
. . k '-g.
~