HomeMy WebLinkAbout1007 ~eclaration ot Domicile and Citizenshlp
TO THE STATE ANU COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the Sta~e of Florida that 1 am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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1 was formerly a legal residenf of ~ C-~3 _S~_~ . - - - -
(City)~ (State) ;
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and I resided at /~.C~~l~ ~?.4"~__.._. 4!__i___ _ However I have changed my domic.ile
iStreet and Number)
ro and am and have been a bona fide resident of the State of Florida since ~C.~>!'4 S~ ~ l~~~ _ day of
, 19_ . _ , and I reside as D / !7 ~3_~~~~
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(Street and Number) {
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fORT PIERCE, 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 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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FILED ~M~ RECORDEC
ST. LIICIC ;,AUMTY fLA.
RQCE~ ?~tTRAS
CIERK CI~CU:T COURT
R~CORD VEP.IFIED~.,..~.~
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I FURTHER CERTIFY that I will comply with al) other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicjie, and I intend to remain in FORT
~ PIERCE, SAINT t,UCIE COUNTY, FlOR1DA, permanently.
~ . . ~ / -
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~ (Name)
~ l`/. ~L o y o
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- . - _ - -
. • - (Address)
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__-L-__- day of , 19 ~
`t Sworn to and subscribed before me this ~ - ~
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~ ROGER POlTRAS - -
K CIRCUIT COURT Notary Public ~
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By O1"~~~__ _ O.C. My Commission expires _
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~ (To b~ ~x~cuhd in duplitat~ and orisinal fil~d with Cl~ric Circuit Court, and dupliut~ with T~x Ass~ssor.)
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~ ° R 190 1004 '
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