HomeMy WebLinkAbout0298 ~
DeCla~ation ot DomiCile and Citizenship 21460'7 ~
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TO THE STATE AND COUNTY TAX ASSESSOR, ~
Sl. IUCIE COUNTY, FLORIDA:
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This is my declaration of Oomicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
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~n conformity with Chapter 222, Section 222.17, Florida Statutes. ~
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I was formerly a legal resident of ~ QL~,~d!.~L,~~__ - - • -
(City) te)
and 1 resided at [c.(1}'2,Q~ _ _ . . However 1 have changed my domiCile
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(Street and Number)
to and am and have been a bona fide resident of the State of Florida since . ~J_~ _~.Q~~ day of
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- - _ - - 19---- and I ~eside at ' -
treet 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, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.) ~
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21460'7
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IUCIE COUNTY flA.
ROCER POITRAa
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~ RECOR~ VERI IEO COURT
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~ Auc 16 10 is AM'11
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~ ! FURTHER CERTlFY that ! wil! co?nply with al! other requ~re~e~ts of a IeQsl r~i~ient o# this State.
I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
(Name) ~
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~ (Address)
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Sworn to and subscribed before me this ~ u~ day of , 19
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RQGER ~OITR/?5.:'".
CLERK GIRCt11~ X~: Notary Public
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By . = D.C. My Commission expires
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(To b~ et~A~d%is diiplitnr:and ori~inaf ~il~d with CINk Grcuit Courf, and dupliuN with Tax Ass~s~or.)
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