HomeMy WebLinkAbout2127 De~laration ot Domi~ile and Citize~ship
2(),~i81
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FLORIDA: ~
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This ~s my declaration of Oomicil~ and Citize~ship in the State of Florida that I am filing this day in accordance and ~
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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! was fe?me~ly a legal residenf of 1G_(.'L~ ZL _._~~''~~'Z-- `
(City) ~ (State)
,
and I resided at ~L L_~ ~-~G;j~ , However I have changed my domiCu~e
(Street and Number)
to and am and have been a bona fide ~esident of the State of Florida since l _ day of
C-
L i c ~ - . ~ 9_~ o. ,~Q~ ~
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and I resi~e at r- --ti~G O«~ CL~
~ (Street and Number)
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 properry or business, or ~elinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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6~ERK CiRCW? ~Rt
~ECORQ VER1FtE0
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~ 1 FURTHER CERTIfY that I wil) 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 domicjle, and I intend to remain in FORT ~
~ PIERCE, SAIN[ LUCIE COUNTY, FLORIDA, permanently. ~ ~
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Sworn to and subscribed before me this ____LL___ day of
- , 19~f .
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ROGER POITRAS
_ ,-~ERK CIRCUI COURT ' Notary Pubtic
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~ u- c l~ e,(? _i
By - - - _ D.C_ My Commission expires -
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(To be executed in dupliuts and original filsd with CI~r{c Grcuit Court, and dupliut~ with Tax Assessor.)
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