HomeMy WebLinkAbout1082 Decla~ation ot Domicite and Cttlze~ship
215156
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FIORIDA
i
This ~s my declaration of ~omicile and C~tizensh~p in the State of Florida that 1 am filing this day in actordance and ~
~n conformify with Chapter 2??, Section 222.17, Flo~ida Statutes.
I was formerly a legal resident of ~~l~.,~
(City) ~St~te)
and I resided at ~ (,Gs(~ - However I have changed my domicile
(Street and Number)
ro and am and have been a bona fide resident of the State of Florida si~ce ~ _ day of
, 19_~0 , and I reside at S~O _~r~~-4~' S~ '
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FIORIDA
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 pe?tinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to ~ew domicile, purchase of home, etc.)
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215156
~i'~~~~~ iIlEO At~tO 4ECORDEe
i1.lUC1E COUMT~ fLA,
ROCEA POITRAS E
CLERK CiRCU1T CBURT {
RECORD YfRIF1ED.,,~~
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently.
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S . C..
~ . . 'p. - ' . r . ' (Address) -
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Swprn to and subxribed before me this day of , 19-__.
ROGER POITRAS
- - - - - - -
GIERK CIRCUIT COURT Notary Public
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~Y _ _ - - D.C. My Commission expires
~(To b~ ~x~cw~d ie duplicat~ and oripin~l ~il~d with Cl~rk ['.i....H ~~+urt, and duplluN with T~x AsNSSOr.1
~ ~~195 ?~10~0
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