HomeMy WebLinkAbout0294 DeClaration ot Oomicile and Citizenship 2 0 6 4 4
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TO THE STATE AND COUNTY TAX ASSESSOR,
51. lUC1E COUNTY, FLORI~A:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in atcordante and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of ~//!9 _I~~? ~E (ti~~l.~__ r_~
(City) (State) ~
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and 1 resided at ~f~ t•FR~t1c~~_7~_/~~~I6U!2__ However 1 have changed my domicjle
(St~eet and Number)
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ro and am and have been a bona fide resident ot the State of Florida since _ day of ~
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_~l ±f L/ . 19_7C , and I reside at r~ yC.~_ ~ e~!!~ L I~~D7
(Street and Number)
E
FORT PIERCE, SAINT LUCIE GOUNTY, FLORIDA ~
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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 factD, 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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ST
~UC E CO~MTY FtA.
ROCER POttRAS
CLERK CIRCUIT COIMT
RECORO YERIFIEO,~~~
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~ 1 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 domicile, and I intend to remain in FORT
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~ PiERCE, SAINi.L~1CIE COUNTY, FIORIUA, permanently.
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_ Sworn to and subscribed before me this day of 19
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~ ROGER POiTRAS _ -
~ ~'~LERK CIRCUIT COURT Notary Public
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g~~t c/~ ac"r f~ t 7'~ D.C. My Commission expires
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~ (To b~ ~x~cutsd in dupticat~ a~d oripinal fil~d with CI~?k G~cuit Cou~f, ~nd dupliut~ with Tax Ass~s~o?.)
~ g~K~.91 293
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