HomeMy WebLinkAbout1015 ~eclaration of DomiCile and Citize~ship
TO THE STATE AND COUNTY TAX ASSESSOR, -
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Sl. lUC1E COUNTY, FIORIDA
This ~s my deciarahon of Domiule and Cit~zenship ~n the State of Florida that I am filing this day in accordance and
n cunformity w~th Chapter 222, Sect~on 222.17, Flonda Statutes.
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I was forme?ly a legal res~dent of r`S~TS v~`1e . __~~OC~1C~__ ;
(Ciy) (State) ~
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and 1 resided at ~~J~S C~~'~~~r~`~`c\ ~r _ _ However I have changed my domicjle f
(Street and Number)
+o and am and have been a bona fide ~esident of the State of Florida since J~~ • ~5 ) day of
• i9-- , and 1 reside at ~ ~~S~c ;c~ `c\ ~r ~ . _ -
(Street and Number)
FORT PlERCE, SAINT lUC1E COUNT1f, RORIDA
and this statement is to be taken as my declaration of citizenship, actuai legal residence and domiciie 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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ST, lUClf COUN
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C[ERI(C:R r'~ttRAs
~ECOR(~ y ~'F~UIt COURT
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~ I RJRTHER CERTIFY that I will compty with all other requirements of a legal resident of this State. €
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. i FURTHER CERTIFY that 1 have no intention to return to my former domi~ile, and 1 intend to remain in FORT
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~ ~~ERC~, SAINT LUGE COUNTY, FLORIDA, permaneMly.
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Sworn to and subscr~bed before me this _ day of - . 19~_.
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R06ER POiTRAS
K CIRCUIT COURT Notary Public
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gY - - - - - - - D.C. My Commission expires
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~ Ro b~ ~x~cuhd in duplicat~ and o~iqinal fil~d with Gl~ric Circuh CouK, and dupliuto witl~ Tix Ass~ssor.) '
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