HomeMy WebLinkAbout0554 ~
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Declaralion ot Don~icile and Citizenshlp
TO THE STATE AND COUNTY TAX ASSESSOR,
51. IUCIE COUNTY, FLORIDA:
This is my dec~aration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal ~esident of p~r~~bL _ - _ - . -
(Ciy) (State) ~
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and I resided at _ C~IIeril j1~l~~p~ . However 1 have changed my domic~ile
(Street and Number)
ro and am and have been a bona fide resident of the State of Florida since 14~ _ _ day of
_ __~ti_ _ _ 19~~1_., and I reside at ?
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, ROR~DA
and this statement is to be taken as my declaration of citizenship, attual legal residence arxi domicile in the State of Flo~ida. ,
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to ~ew domicile, purchase of home, etc.) ;
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~at~rist Dr~i1 ia tbe lsi S~d~
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FILEO ~RL RECJROED
iT. IUCiE COUMTY FLA.
RO~E~ P~~tRAS
CIERK CiriCU1T COURT
~ RECOR~ VE~. ~'~EO~..~
f~e 15 9 os AN'Ti
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~ I:~URTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
! FURTHER CERTIFY that I have no intention to ~eturn to my former domi~ile, and 1 intend to remain in FORT
~
~ PIERCE, SAIN LUCIE COUNTY, FLORI~A
j , permanently.
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~~j~,,'~~:Q' ` G~jrls H+assoe~ NoH~r~se
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; ~Sviitltli'~o and subscribed before me this i~b day of ~ti~i! , 19Z.
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ROdER POITRAS i
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~ IERK CIRCUIT COURT Notary Public ;
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By D.C. My Commission expires ~
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~ (To b~ ~xecuMd in duplicah snd ori~inal filad with Cl~rlc Cirwit Court, and duplicaN with Tsx Ass~ssor.)
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