HomeMy WebLinkAbout0903 Deciaration ot Donticile and Citisenship
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TO THE STATE AND COUNTY TAX ASSESSOR,
51. IUCIE COUNTY, FLORIDA: ;
This is my declaration of Domicile and Citizenship in the State of Ftorida that I am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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I was formerly a legal resident of _
- - - - (Ciy) - - - - tate)
, However I have chan ed m domic.ile
and I resided at . . g y
`G~
(Street and Number) `
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to and am and have been a bona fide resident of the State af Florida since _ day of
- - _ _ _ _ _ 19 ~ , and I reside at ~ _ ~
' ` - -
~ ~ ~ (Street and Number)
FORT PIERCE, SAINT LUCIE COUNTV, RORIDA
and this stateme~t is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of properry or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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S1LlUClC~ OUNtY FlA-
ROGEF ?~ItR~S
CIER YER~ IEO COU~"
RECQAD ;
fEe 19 1 2o PN'11
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiule, and I intend to remai~ in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIUA, permanently_
, ~ ` LG Gr/ri~
. . ~ ~ ~ me) - -
~ . , - ' ~r porothy J Atkins
~ •~tc~:~~' G ~ -
~ . . . , ~ (Address)
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~ ~ Swom to and subscribed before me this ~ day of , 19L.
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~ ROGER POITRAS _ _
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~r K CiRCU1T COURT Notary Public
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8y G~'~
~~~~1'~~ _ 0.C. My Cammission expires
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(To b~ ~x~cut~d in duplicat~ and oripinal ~il~d with Cl~rk Grcuit CouN, and dupliut~ with Tax Asstssor.)
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b00K 1~11 ~Q~
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