HomeMy WebLinkAbout0702 Deciaratlon ot Domicile and Citize~ship
TO THE STATE AND COUNTY TAX ASSESSOR, ~ O B~ 0~
Sl. IUCIE COUNTY, FlOR10A:
:
This ~s my declaration of Oomiule and Citizenship in the State of Florida that I am filing this day in accordance and ~
~n conformity with Chapter 222, Section 222.17, Floride Statutes.
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I was formerly a legal resident of ~~~`-~-~--~et°../ `~<<r--_~~ 1
(City) (State)
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and 1 resided at F' ~y.C.1-~~[~~`~"~ ~I~'`~'u`~- However I have changed my domicjle ~
(Street and Number>
ro and am and have been a bona fide resident of the State of Florida sinte ~-~~"Jh[-u'Z~ y, /~7G day of
.
. , 19_ , and I reside at /./a ,~f.~ _//.~?a ' ~lc`e _ --r~: - ~
(Stree and Number)
fORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actuat 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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206708
F«EO ~no REC~no~E~ . ~~,.~a i . ~o-x
ST. LUCtE COUN Y ~ •
ROC~R PO~~
COURZ ~ ~
' C~ERK C1~CU1
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~ I FURTHER CERTIFY ihat I will comply with all other requirements of a legal resident of fihis State.
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~ 1 FURTHER CERTIFY that I have no intention to retum to my former domiCile, and I intend to remain in FORT i
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanent{y. . ~
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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
: B ~~~~`~~v _ D.C. My Commission expires _
F~;
_ (To b~ ~xecuted i~ duplicats and originsl ~iled with Cl~rk Grcuit Courf, and dupliute with Tax Assessor.)
~ „ s~K ~91 ?p~
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