HomeMy WebLinkAbout2981 Declaratlon ot Don~iCile and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR,
• i
Sl. LUCIE COUNTY, FIORi~A:
This ~s my detlaration of Domicile and Citizenship 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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I was tormerly a legal :esident of _ _ - -
(Ciy) (Stat
and I resided at ~ _ _ _ _ . _ _ _ _ _ _ However I have changed my domiCile
~ (Street and Number)
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to and am and have been a bona fide resident of the State of Florida since °2° _ day of
_ , 19 _ d , and I ~eside at ~~zO,~'~~-' ~G ~'`'t~1 .
~ (Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence a~d domicile in the State of florida.
(Insert here any pertinent facts, such as sale of property or business, or retinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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206261
FILfO ~MO RECg1tQ~Q
5T. ROGER~POIT~A= I1
CIERK CIRCU f!
RECORa YERIFIE ~
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~ I FURTHER CERTIFY that I will comply with all other requirements of a IeS,~al resident of this State.
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~ t FURTHER CERTIFY that I have no intention to return to my former omi ' e, and I intend to ~emain in FORT
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ j J J C r - - ' - i
~ - • : . ~ f . ~ (Name)
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~ Swom to and subscribed before me this ___/L--__ _ day of ` _ _ 19_LL_ . ~
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~ R ER POITRAS - - -
~ K CIRCUIT ~OURT Notary Public
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By D.C. My Commission expires '
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~ (To b~ ~x~cutsd in duplicats and ori~inal filsd with Clt~lc Grcuit Court~ and dupliut~ with Tax Ass~s~or.)
~ ~aoK 19i1 29i?
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