HomeMy WebLinkAbout1092 Declaratie~ ot Don~icile and Citisenship
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TO THE STATE AND COUNTY TAX ASSESSOR,
51 IUCIE COUNTY, FIORIDA:
This is my declaration of Dom~cile and Citizensh~p in the State of Florida that 1 am filing this day in accordance and '
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~n conformity with Chapter 222, Section 22Z.17, Florida Statutes. j
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1 was formerly a legal resident of :.G _ . _ _ ~ C!~~ - _ ~
~~~(City) ~ (State) :
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and 1 resided at L 4~ _ ~Q'~~ However I have changed my domiG~e
eet and Number)
ro and am and have bee~ a bona fide resident of the State of Florida since _ day of
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~~9'~'L " , 19~U , and 1 reside at LL~ g _~~~~'S~C-_ -
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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 forrner domicite, removal of family to new domicile, purchase of home, etc.)
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~l ~(iLt 1 L((~,Q~~K-Gt~. fIlEO AM~ REC4RDE!
S7- LUCIE COUNTr f~
ROCER POITRAS
1tf CORC 1?f R!flES ~O~T
fEe 12 1 ~ PM'll
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~ I FURTHER CERTIFY that I will comply with all other requiremenis 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 domiule, and I intend to remain in FORT :
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~ PIERCE ~SA1Nj,LUCIE COUNTY, FLORIDA, permanently. ~
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Swom to and subscribed before me this day of 19-L--
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~ ROGER POITRAS - - - -
~ ' K CIRCUIT COURT Notary Public
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By_, ~`-~~'Q-___- D.C. My Commission expires _
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(To be executsd in duplicate and originsl fiiled whh Cl~ric Circuit Court, and dupliute with Tax Assessor.)
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~ sooK 190 1089
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