HomeMy WebLinkAbout0052 DeGlaratio~ ot Domlcile a~c! ~itise~shi~
TO TNE ST4TE ANU COUt~TY TAX ASSESSOR, ~ 2O
Sl. lUCIE COUNTY, FIORIDA
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordanca and ~
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~n conformity with Chapter ?2?, Section 222.17, ~lorida Statutes.
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1 was former~3• a legal ~esident of __N~!i__FQ~~_ _~L~~3 ~
~City) (State)
and I resided at 8~~~ T l~~~Slf} ~~Q/ ~+C Howeve? I have changed my dorniciie ?
(Street and Num~tr) ~
ro and am and have been a bona fide resident of the State of Florida sinte N_~_- day of
F~~~ ~Iq/Qy _ - . 191~_ , and I reside at .~l1QQ ~~REENl.vOQ7! ~IP/ If~ - ~
(Street and Number)
FORT PIERCE, SAINT WCIE COUI~lTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actval legal residence and domicile in the State of Flo~ida.
(Insert here a~y pertinent facts, such as sale of property or business, or relinquishment of employmen!
at former domicile, removal of family to new domicile, purchase of home, etc.)
Reaidence _
3
212'~~~
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~At~
~ REC41~~~ R~ .
~ ER~f~~ ~,/V~ _
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~ ! FURTHER CERTIFY that I will comFl~ with all other requirements of a tegal resident of this Stste. ~
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1 FURTHE2 CERTIFY that I have no intentio~i to return to my former domicjle, and t intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, ~ermanently.
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~ (Name)
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~ (Address)
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~ Sworn to and subscribed before me th~s ___1Hth _ day of _ June _ ~ 19 'jl ;
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~ ~L '~i~?. USl~ ~
ROGER POITRAS • '
~ CLERX CIRCUIT COURT ~ tVotary Pu Yic ~ ' ~
~ BY _ _ _ . _ - _ - _ D.C. 1Ny Commission expires ` xadefiaite .
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~ (To b~ ~x~evt~d in dupiieat~ a~el oriVi~~l ~il~d with Cl~rlt Grevit Court, and duplieat~ with Tax Assossor.)
~ ,3 g~~,19~ ~2
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