HomeMy WebLinkAbout1386 Decfaratio~ ot DoMicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FIORIDA: ~C ~
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This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and ~
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~n conformity with Chapter 222, Section 222.17, Florida Statutes. !
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1 was formerly a legal resident of ~ a'-~-- '
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and I resided at y 8 ___C_JC.l~t~r However I have changed my domiCG~e ~
(St~eet and Number) ~ ~
to and am and have been a bona fide resident of the State of Flo~ida since ~ . day of
- _ _ _ , 19~4 , and 1 reside at l0 a~ ~ - - ~ ~ -
~ (Street and Number) E~
PORT PIERCE, SAINT LUCIE COUNTY, FLORIOA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Flo~ida.
(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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F~~EO Ah~ ~:ECO~oEo
s?,IUC~f^COUNTIf FIA.
ROGEM ?O~TRAS
CIERK U{CUIT COURT
RECORD ~fRtFIEO~~.:~~ ~
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State. ~
1 FURTHER CERTIFY that 1 have no intention to return to my former domiule, and I intend to remain in FORT
PiERCE, SA(NT LUCtE COUNTY, FLORIDA, permanently.
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(Name) ~j
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~ , yt;~ r~~{~ibstribed before me this ~ day of _ , 19~.
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~ , ,~,r ~ ~OURT Notary Public
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~ gy O.C. My Commission expires _
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~ Ro b~ ~x~cuMd in dupliute and oripinal fil~d with Cl~rlc Circuit Cou~f, and duplicat~ with Tax Ass~ssor.)
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ao~190 1383
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