HomeMy WebLinkAbout0639 D~claration ot Domicile and C~tisenship
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TO THE STATE AND COUNTY TAX ASSESSOR
51. IUCIE COUNTY, FIORIDA:
This is my declaration of U~micile and Cit~zenship in the State of Florida that 1 am fil~ng this day in accordance and
~n confo:mity with Chapter 22?, Section 2?2.17, Florida Statutes.
1 was formerly a legal residenl of ~~V _ M a: V_ _ /V C-~ E~t ~ E~"
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and I resided at Y S o T.f r, i t t t / t7 71 jG S However I have changed my domiGle '
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(5treet and Number)
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to and am and have been a bona fide resident of the State of Florida since 3 v day of
J~~ E 19_~ and 1 reside at ~ 9 v y w~ ory..•~ ~ t-~
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(Street and Number)
FORT PIERCE, SAIN? LUCIE tOUNTY, FtQitIDA
and this stafement is to be taken as my declaration of citizenship, actual legaf resi~ence and domicile in the State of Florida.
(t~ser~ here any pe~tinent facts, such as sale of property or business, or reiinquishment of employment
at former domicile, rem~val of family to new domicile, purchase of home, etc.)
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ST~lUC1E COUNTY F~~
ROCER P~tTRAS t
CIERK CIRCUIt COIMT
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' RECORO YERIFIED.",~~
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1 FURTHER CERTIFY that I will comply wi*h all ofher requirements of a legal rPsident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domic,ile, and I intend to remain in FORT
PIERCE, SAINT IUCIE COUNTY, FLORIDA, permanently.
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~ Sworn to and subscribed before me this __°`Sc~ day of 19~_. +
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ROGER POITRAS
CLERK CIRCUIT COURT Notary Public
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gy D.C. My Commissior. expires _
~ (To be sRecuted in duplicats and oriyinsl filed with Cl~rk Circuit CouA, snd duplicate with Tax Ass~ssor.)
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~ ~k194 639
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