HomeMy WebLinkAbout0246 Y .
Decla~ation ot Domicile and Citiz~nship
TO TNE STATE AND COUNTY TAX ASSESSOR, ~ Q 6 A O~
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Sl. lUC1E COUNTY, FLORIDA
Th~s +s my dedaration of Domiule and Cifizensh~p in the State of Florida that 1 am f~i~ng this day in accordance and
n conformity with Chapter ?22, Section 222 17, Florida Statutes. #
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I was formerly a legal resident of `v • ~
(City) ate) ~
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and 1 resided at J ~ L• Howeve? I have changed my domicile ~
(Street arid Number) ~
~o and am and have been a bo~a fide resident of the State of Florida since ~ day of
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~~~c-<-~--i , 19~0, and I reside at ~ ~ _ - -
~ (Street and Number)
FORT PIERCE, SAINT IUCIE COUNTY, PLORIDA
and th~s statement ~s to be taken as my decla~ation of citizenship, actual iegal residence and domicile in the State of Flo~ida.
(Insert here any pertinent facts, such as sale of property or business, or refinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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i~ FtlEO ~MO RECpR
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,f ST. LUCtE CQUNTY ~ v^
I/= ?~i~-~ lr~ ~ ROCER POITRAs ~
CIERR CIflCU1t COW1T ~ ~
RECORO rER~F~EO.~,~,
~ur 19 3 07 PM'TI `
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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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~ t FURTHER CERTIFY that I have no intention to return to my former domiule, and I intend to remain in FORT
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` PIERCE, SAWT LUUE COUNTY, FLORIDA, permanently. ~
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~ / (Name) L eQ ~j ~ i
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(Address)
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_ Sworn tq.and subscribed before me th~s ~ day of __`~`~f~ 1~ _ 19 ~I.
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- ROGER I'bT7RA; ~ - -
- CLERK CIRCi111j COURT ~ Notary Public
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_ By `__'2~._`11-~__ D.C. My Commission expires
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_ (To ~w yr~tlFcuted in duplicate and originsl filed with Cle~tc Circuit Court, and dupliuts with Tax Assessor.)
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