HomeMy WebLinkAbout1714 Decla~atjon oi Domicile and Citise~ship
~O THE STATE AND COUNIY TAX ASSESSOR, • ~
~135C~ !
Sl IUCiE COUNTY, FtORIDA i
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ih~s ~s my declara~~on ot Uom~ci~e and Cihzensh~p in the State of Florida that I am f~l~ng this day in accordante and
~n conformity with Chapter ?22, Sect~on 17, Florida Statutes.
.
1 was formerly a legat resident of f ~ xl.~~ _ _
(C~y) (State)
and I resided at ~jp-tj ~1 ~ 3 Noweve~ 1 have changed my domic,ile
(Street and Number)
+o and arn ~nd have been a bona fide resident of the State of Florida since G~ ~ ~ day ot
. 19 . and I reside at 3 yo ~~r-~-f~
(Str and Number)
FORT PIERCE, SAlNT IUCIE COUNTY, FtORIDA
and th~s statement ~s to be taken as n~y declaration of citizenship, actual 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.)
~:l~ R~_Q Lo~. i~ r~.,v ~~(A1 c~-e _ Ct~< 1'1
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`~\C•~~;R _ cic 1`3 fIlEORMDRECORpEo
c~" ~ ST. UiC1E COUMTY fLA.
ROGEA ?OiTRAS
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~ ~ ~ ~ RECORO vEaiFiEO~'~
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I FURTHER CERTIFY that 1 w:;l comply with al) other requirements of a(ega) resident of this State.
~ I FURTHER CERTiFY that I have no intention to return to my form~r domicjle, and t intend to remain in FORT ~
~ ~I[RCE, SAINT LUCIE COUNTY, FIORiDA, permanently. ~
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j~.%~~'~'.~-s-~~~_~ ~ -
; : , (Name) '
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~ ~~rqr:r-te~~lnd.si{blcribed before me this _ ~v_ day of _ - / - 19_?
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~ ROCER POITRAS
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~---~C K CIRCtJIT COURT Notary Public k
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~ 8Y - ~ 'S~ ~ 1')^- _ D.C. My Commission expires - - :
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f~; (To b~ ~xscuted in duplicat~ and ori~inal fifed with Cl~rk Circuit Court, and dupliut~ with T~x Ass~sso~.) !
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_ b~,.,~1~4 1713