HomeMy WebLinkAbout1160 OeClaration ot Do~nicile and Citlzenship 20~~~3
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FIORIDA:
i
i
This is my dectaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and #
~
~n conformiry with Chapter 222, Sectio~ 222.17, Florida St~tutes. ~
~
~
;
I was formerl a I al resident of /~T _ ~L E!!!S i ;
Y e9 _ - - - ~
(City) (State) ;
and 1 resided at _ ~ 7 F S/___ __~'~!'9S 7'_~_ However I have changed my domiG~e
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since A G/G_ day of
_ _ _ ~ _ _ _ _ 191. and I reside at _ 9 Q 3_ _ S~ I~?o i.o~. ,C7.~ . !
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
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 fo~mer domicile, removal of family to new domicile, purchase of home, etc.)
q Po~/ ~ r~,~ /~.~,t s~~p ~ 2U4983 ~
ST
~i~CtE COUNTY FIA.
ROCER POITRAS
CLERK CtRCU1T COURT
RECORO VERIFIEO~~
fE8 ~3 I 43 PM'T1 ~ ~
~ ~
~
f
'r
€
E
's
a
~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
S •
~
~ I FURTHER CERTIFY that I have no intention to return to my former domiCile, and 1 intend to remain in FORT
s
t PIERCE, SAINT IUCIE COUNTY, FLORIDA, permanently_ -
~ ~~t?~.t~:~r.,~,; .
~ = ~ ~
tv.
~ •f~~;~ 7~+ ame) ,
~ g~.~ Josep J $o
~ o
~ ~ r
: : s...
' ,~i~ ~ : ~ ~'1 c7 3 S ~ . a~,~ ~.z
; ' . ~ ' - , :
~ N~.~ ` ~~'~t:'~ s~~,.•`~`r~ . • - (Address) ~
'C
:K.,~d'~:~;~-,=.~~.~ -
~ ~Jc' 1 C'~i`~•`~: ~ ~ ~ ~LC/~ ~
;c Swom•~d subscribed before me this ~ day of , 19~~
s
Y:
~ R ER POITRAS
~ - -
~ K CIRCUIT CO T Notary Public
~ ~
~ t,~. !J-L~t
Vs 6Y - - D_C. My Commission expires
~ {
~
~
~ (To b~ ~xecut~d in duplicat~ and oripin~l ~il~d witb Cl~rk Grcuit Court, and dupliut~ with T~x Assessor.)
~ , ~ ~.90 ii57
~ - ~ ~ =
_
1. . _ - ~ . ~ _ , ,v~~