HomeMy WebLinkAbout2430 Declaration ot Domicile a~d Citisenship
20580~
TO THE STATE AND COUNTY TAX ASSESSOR,
51. lUC1E COUNTY, FIORIDA: '
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This is my declaration of Dom~ule and Citizenship in the Stare of Florida that 1 am filing this day in accordance and j
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~n conformity with Chapter 222, Section 222 17, Florida Statutes.
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1 was formerly a lega! resident of `~~~Q. _ ~ - -
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and 1 resided at ~J. U' ~~r~~-~~=~'~ - However I have changed my domiCile
(Street and Number)
to and am and have been a bona fide resident of~the State of Florida since _ . _ day of
V 7'Z-~'sl'1'~Y'L , 19J~ , and I reside at ~i' ~ ~ - ~,~~~~--t/`r' -
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(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, KORIDA ~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the 5!ate 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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20580f
ftlEC ANO RECOR4~ ~
S?.L11CIE COWITY ~ ;
R06ER MITItA: t
C~fIIK CIitCUR COItQT
RECOlt~ IfERtF1E0......~.~~
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I FURTHER CERTIFY that I will comply with all other requirements of a lega) resident of this State.
1 FURTHER CERTIFY that I have no intention to relurn to my former domiule, and 1 intend to remain in FORT
PiERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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. ¢C.'~}: (Name ~
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~ ' ~~i r •~•,L`subscribed before me this ~_.f_ / _ da of ~ Q"2"~ ~ , 19
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~ R0~3ER POITRAS -
LERK CIRCUIT OURT Notary Public
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By ~L~~--_____-_____ D.C. My Commission expires
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~ (To b~ ~xecut~d in duplicat~ and ori~inal fil~d with Cl~rk Circuit Court, and dupliut~ with Tax Ass~sso?.)
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