HomeMy WebLinkAbout2143 r
Deciaratio~ ot Dorr~icile and Citizenship 2U55.~~.
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FIORIDA:
This is my declaration of Dom~ule and Citizensh~p in the State of Ftorida that 1 am filing this day in accordance and
~n conformity with Chapter 22?, Section 222.17, Florida Statutes.
1 was formerly a legal resident of ~A~'!!~J!`~ _ ~iv~AR!.~ CA'uADA
~C;ty~ (State)
and 1 resided at ~Q~ ~T/1Q701~ _ yd eTH However 1 have changed my domi~ile ~
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since - day of '
3Ad/u AR~ , 19.~~ , and I reside at ~ a X y0~ I(..5. /`VW 1~
(Street and umber)
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 Fiorida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishmsnt of employment
at former domicile, ~emoval of family to new domicile, purchase of home, etc_)
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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 I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. TE ~iL~ CA.V
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"Sy~iorrrto'1t~dssp6~scribed before me this - day of - --A!QL , lq~ '
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ROGER POITRAS _
~ C CIRCUIT COURT Notary Public
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By 0.C. My Commissio~ expires
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~ (To bs executed in duplicate and original fiiled with Clerk Circuit Court, and duplicate with Tax Assessor.) ~
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