HomeMy WebLinkAbout0454 . -
DeClaration 4t Doml~ile and Citfser~achlp
t0 TNE S~ATE AND COUNTY TAX ASSESSOR, ~~c~~
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Sl. IUCIE COUNIY, FIORIDA
fh~s is my declaration of Domicile and Citizenship in the State of Florida that I am fii~ng this day in accorda~ce acid
~n conformity with Chapter 222. Section ?22.17, Ftorida Statutes. ,
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1 was forn~eriy a legal ?esiden: of C~ ~~G ~ L~? C~ /~/-'~t' -L`
(City) (State) ~
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and 1 resided at ~7 :.lr ~!~-~t 'l,,'G~ ~-'-t"- ~"'"~~'~'`-"Z l How~ever 1 have changed my domicile i
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ro and am and have been a bona fide ~esident of the State of Florida since ~ day of
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~~O ~ lL ~ , i9_~ ~ , and 1 ?eside at ~ _ .
(St-Pet a~d Numbe~l
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FORT PIERCE, SAINT LUCIE COUNTY. FLORIDA
and this statement is to be taken as my declarateon of citizenship, actuaf legal residence and domicile in the State of Florida.
(Inserf here ar.y pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, rernoval of family to ~ew da,nicile, purchase of home, etc.)
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F~LEQ A+10 RECOAQE~
aT. IUCI~ COtlNTY ~4 • j
IIOC£R ?01~I1~: -
CIERR CtRCU1T CCURT a,,~,~
RECORO VERif1E0~
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~ 1 FURTHEit CHtTIFY that I wil{ comply with a11 other requirements of a~egal resident of tfiis State.
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~ I FURTNER CERTIFY that I have ~o intention io set~rn to my former domi~ile, and I intend ta remain in FORT
~ alE2CE, SAINT LUCIE COUN~Y, FLORIDA, permanentiy.
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~ _ _ - - - ~Name) - -
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~ Swo~n to and wbscribed before me this day of • 19-~~
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ROGER lOItRAS ~ ~ ~ -
GIERK CiRCUIT COl1RT Notary Pubtic #
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~ gY ' U.C_ My Comrnission expires t
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~ (To be ex~ccAed,~n dvp~~cate ~nd ori~i~al filed with Clerk Grcuit Court, and duplicate with Tax Assessor.)
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