HomeMy WebLinkAbout2789 Declaration ot Domicile and Citizenship
TO THE STATE ANO COUNTY TAX ASSESSOR. 214263
51. IUCIE COUNTY, FLORIDA:
This is my decla~ation of Dom~ule and C~t~zenship in the State of Florida that 1 am f~ling tnis day in accorda~ce and
~n conformity with Chapte~ 222, Section ??2.17, Florida Statutes
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I was fo~merly a legal resident of ~~(~~"I~rit.t/~l - _ ' l
(Ciry) (State)
,
and I resided at /~U i~r(/~Q~ However 1 have changed my domicjfe
(Street and Number)
fo and am and have been a bona fide resident of the State of Florida since ~7 day of
, 19_./~ , and I reside at . _
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my 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, ar relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
)'p,~, L%~ 1.~~~~~UG~~ ,.L~~ ,/~G ' ' F~LE~ A«
~j~~~.~LV~G~J D RECOROEO
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i/~(~~~ RECO~D vE~~F1E0
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I FURTHER CERTIFY that I will comply with all other requiremenis of a legal resident 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 ~~lCIE COUNTY, FIORIDA, permanently.
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~ . S/_ -
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~ . (Name)
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~ Sworn to and subscribed before me this da of ~ 19
~ ~ - - Y -L- L~ T • ~f
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ROGER POITRAS - - - - - - -
~ CIFRK CIRCUIT COURT Notary Public
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~ BY - -1~,~~ - ~ D.C. My Commission expires -
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~ (To be executed in duplicate and original filed with Cltr{c Grcuit Court, and duplicat~ with Tax Assesso?.)
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, ~~~~194 2787