HomeMy WebLinkAbout1006 Dealaration ot Don~iclle and Citizensh~p ;~1511~
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FIORIDA:
This is my declaration of i~micile and Citizenship in the State of Florida that I am filing this day in actordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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I was formerly a legal resident of _ _ - - - --t-- - (
(City) (State) i
,
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and 1 resided at . However 1 have changed my domitile f
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(Street and Number) ~
to and am and have been a bona fide resident of the State of Florida since _ day of ~
- - 19-~..~• and I reside at -
(St~eet and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIOA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile i~ the State of Florida.
(Insert here any pertine~t 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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FILEO A?10 RECORpEG
ST. ~UCIE COUNTY flA.
ROCER POITRAS
• ClEtiK CIRCUIT COUAT
RECORD VERIFIEO~.,.
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I RJRTHER CHtTIFY thst 1 will comply with all other requirements of a leqal resident of this State. ~
I FURTHER CERTIFY that 1 have no intention to return to my former domiGle, and I inte~d to remain in FORT
FIERCE, SAINT LUCIE COUNTY, fLORIDA, permanently.
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~ ~ ' ~ . _ . (Name)
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( dress)
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~ ..''.Sy?prqYO end suburibed before me this day o _ , 19 .
~ RO~iER POITRAS ~
~ t~ERK CIRCUIT COURT Notary Public
~ 8y `t'~""-"~- D.C. My Commission expires
(To b~ ~x~euhd in dupliut~ and oripinal Rl~d whb Cl~ek Cireuit Cou~f, and dupliut~ with Tax A~s~or.) • ~g
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A aoQK 195 PACE 1004 ~
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