HomeMy WebLinkAbout2370 De~latation ot Domlcile and Citlsenship 2 0 5 7 5 2
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FIORIDA
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This ~s my declaration of Dom~cile and Citizensh~p in the State of Florida that I am filing this day in accordance and ~
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~n conformity with Chapter ?22, Section 2?2.17, Florida Statutes. ~
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I was formerly a legal resident of L~ _
(City) (State
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and I resided at !~~t~L ~x~~vGl~~ However 1 have changed my domiGle ~
(Street and Number) ~
fo and am and have been a bona fide ~esident of the State of Florida since R day of
`1~/~llJi.C~' , 19~~ . and I reside at /l~ ~~`,~'C'~c4~ _ ' ~~'G~-L-' -
(S1Yeet and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FIORIDA
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 former domicile, removal of family to new domicile, purchase of home, etc.?
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2 05 752 ,
fILEO AMQ 4EC4RQED
tT. WCtE COUNTY FLA. _
ROCER POITIIAS -
ClE1lK C1RCUIT C01lRT
RECORO YERtF1E0.~~
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~ I FURTHER CERTIFY ihat 1 will comply with all other requirements of a iegal ~esident 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
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~ °~ERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. i
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~ ^~l `~~4 -~rtA" L~.~. ;
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r - . . Ias J. ~ol~lis
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Sw~om'to and subscribed before me this day of _ , 191L .
ROGER POITRAS ~
~ tERK CIRCUIT~OURT Notary Public
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By _ 0.C. My Commission expires
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`'s"; {To b~ ~xecuNd in duplicats snd ori~insl filed with Cls~lc Grcuit Couet, and dupliut~ wi~h Tax Ass~ssor.)
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