HomeMy WebLinkAbout0876 Declaratia~ ot Oomicil~ and Citisenship
TO TNE STATE AND COUNTY TAX ASSESSOR, ~
51. IUCIE COUNTY, FIORIDA: ' '
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lhis is my declaration of Domicile and Citizenship in the State of Flo?ida that I am filing this day in accordance and
~n conformity .vith Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of .~"ifG41~~^=--- ~ - - - - - - -
(City) t5tate)
and I resided at -_7 0~-~~-Z _.(!!ad_. . However 1 Have changed my domiti~e
(St~eet and Number)
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to and am and have been a bona fide resident of the State of Flo~ida since _ day of "
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~_.Q~T- _ 191~ , end I reside at Q.D-
(Street and Number)
F~RT P{ERCE, SAINT 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 pertinent fatts, such as sale of praperty or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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f lE0 ~N~ R~CORQED
IIOCER PO TRAS`~
CIEaR CIttCU1T COUIIT
RECoaO vEA~f1E0..~-~
fEO 19 10 s9 AN'T 1~
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~ I RIRTHER CERTIFY that I will comply with all other requirements of a legal resident of this State. i
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I FURTHER CERTIFY that I have no intention to return to my former domicjle, and 1 intend to remain in FORT
~ PfERCE, SAIf~T.~UC1~ COiJNTY, FLORIDA, permanently.
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Sworn to and subscribed before me this day of - _ _ _ _ _ _ ,
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~ ROGER POITRAS
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~k CIRCUIT COURT Notary Putslic t
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By ~`'~`"e"e' D.C_ My Commission expires t
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(To b~ ~x~cvt~d in dupliuh and ori~enal fil~d with C{~rlc Gnuit Court, and dupliut~ with Tax Ass~ssor.)
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