HomeMy WebLinkAbout2081 O~claration ot pomi~il• snd Citis~nship
TO THE STATE AND tOUNTY TAX ASSESSOR,
51. lUC1E GOUNTY, FIORIDA:
Th~s is my declaration of Domicile and Citizenship in the State of Florida that I am filin~ this day in ~caords~ce anc3
~n co~formity with Chapt~ 222, Section 222.17, Florida Statutes. _
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I was forme~ly a legal resident of _s~- _
ity) (Stah)
and I ~esided at --~p~-~ - However 1 have charped my domitile
t and Nurrsber)
ro and am and have been a bona fide resident of the State of Florida since _ day of
- - - - . 19~_. and 1 reside at , ~ ~t•
(Street and Num~)
fORT r1ERCE, SAINT LUCIE COUiUTY, RORIDA
and this statement is to be raken as my declarotion of citizenship, actual legal residence and domicile in the Staro of Florida.
(Insert he~e any pertinent facts, such as sale of property or business, or relinquishme~t of employment ,
at fcrmer ciomicile, rernoval of famiiy to new domicile, purthase of fiome, eft.)
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- F~~En ~WO aECOa~o
- 3t LIICIE COUNTY tA. `
~OCER POITRAS ~
CIEIiK CIRCtl1T COWtT
pEC0110 VERIFIEO~...~~ ~
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1 FURTHEit ~ERTIFY that I will aamply with all ofher rsquirement= of a tepal resident of this Stste.
1 FURTHER CERTIFY that 1 have no intention to return to my former domicjle, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently.
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~~.to snd subscribed before me this day of , 19 .
.~ts~
ROGER rO1TRAS ~
CIRCUR ~OURT Notary Public
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g~ O.C. My Commisiion expires -
(To b~ ~x~cvbd in d~pliut~ •nd orioinal fibd wMb Cl~rlc G?c~il Co~~, ~nd duplleal~ with Tax A~~.1
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