HomeMy WebLinkAbout1754 1
Oeciaration ot Domicite and Cit~zenshlp
TO THE STATE ANO COUNTY TAX ASSESSOR, .
Sl. LUCIE COUNTY, FIORIDA: ~15566
~
This is my declaration of Domicile a~d Citizenship in the State of Florida that I am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
~
1 was formerly a legal resident of ~
(Ciy} (State)
~ ~ r
and I resided at However I have changed my domiCile
(Street and Number) _
ro and am and have been a bona fide resident of the State of Flo~ida si~ce _~~~~"C/C• j~day of
- - . 19 and 1 reside at _~IL; ~ ~ ~~~~2~ .
(Street and Number) ~ '
I
i
FORT PIERCE, SAINT WCIE GOUNTY, PLORIDA j
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida. I
1
(Insert here any pertinent facts, such as saie of property or busi~ess, or relinquishment of employment M' !
at former domici~e, removal of family to new domici~e, purchase of home, etc.)
S fli[D AYfl ~ECfl~bEO
ST_ WL;L ;,~1tTY Fill
` R06tF r~DITRAS ~ ~ ~ !
1 ~1 CLERlt ~i~:CWi COURT '
- ~ ~ ~ RECORc~ YE~I~FIEO.~~.
~ r~ ~ 14 #M'7 ~
-~,~.~a s~ I ~ 1
l , .
,
zsssss
~ ~
l~ ,,~,n~~ . . .
~ ~
~ ~
f ~ ~~~/a~
I ' 1 d~ ~ .
~ _ ~
- ~
~r~~, .
~ ~
~ ~ ~ ~
z~-
I FURTHER ~ERTIFY that 1 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 domitile, and 1 intend to remain in FORT
PIERCE, SAIN7 IUCIE COUNTY, FLORIDA, permanently.
r----
..f ;
rs -
(Name) ~
,
~ • ~J , • , , r
-s. ~ ~ / /
• , ~ -
~ (Address)
t . ~
' . .
. •
~ Sk+roi~i to end subscr~bed before me this ~ day of ~-`~'1-' , 19~. I
ROGER POITRAS
~ LERK CIR~ COURT Notary Public
By °`'t'~'~ ~h"~~* O.C. My Commission expires
(To be executed in duplicate and origiAal fi(od with Clerk Circuit Court, and dupiicat~ with Tax Assessor.)
aooK 195 P~~ 1752
t.o ~ 3 A
- ~ ,Y , - . i?
y F'~'~
,