HomeMy WebLinkAbout1669 Declaration ot DomiCile and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR. `
51. IUCIE COUNTY, FLORIDA~
This is my detlatation of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
conformity with Chapter ?22, Section 222.17, Florida Statutes. .
I was formerly a legal resident of '~'~o/~~~ ~~~_h4~_n~_
(City) (State) ~
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and I resided at'~~ ~~~'QS~~~ ~ G~!q~/N~f- ~1~7~ ~9 However I have cha~ged my domi~ile ~
(St/eet and Number) t
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to and am and have been a bona fide resident of the State of Florida since T~~ ~d day of $
. 19_7U , and I reside at ~yG ~ ~ ~ ~r~/~ _oSJ1.~ `I~ / ~~~l~e- ~ 1
(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. f
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(Insert here any pertinent facts, such as sale of property or business, or relinquishme~t of employment
~t former domiciie, removal of family to new domicile, purchase of home, etc.)
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fllf0 AKp RE~
y„~~ ~ea d~/?'~~ ~ar.~ucrE cpuNTr
CkERK
C RC~IT~pWtT
•RECORO VERIFfEO~~
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~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domiule, and 1 intend to remain in FORT
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~ PI~RCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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_ t SQvpM'~c~:end subscribed before me this _ _ day of _ _ 19?~
,..~ff~~:t .
~ ROGER POITRAS - -
; K CIRCUIT OURT Notary Public
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By. D.C. My Commission expires _
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_ (To b~ ~xecuted in duplicat~ snd ori~inal filsd with Cl~rk Circuit Couef, s~d dupliute with Tax Ass~ssor.)
~ , ~ aoo~ 190 1665
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