HomeMy WebLinkAbout2129 Dectaration of Domiclie and Citizenshtp
TO THE STATE AN~ COUNTY TAX ASSESSOR, ~ 215814
Sl. IUCIE COUNTY, FIORIDA:
This is my declaration of ~omicile and Citizensh~p in the State of Floride that 1 am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Flo~ida Statutes. ~
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1 was formerly a le9al resident of ~ti"~
(C;ty) (Stste)
and I resided at _,1~ ~`21r' l~- ~V~- . However 1 have changed my domiCile ;
(Street and Numbe~) ~
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to and am a~d have been a bona fide resident of the State of Florida since day of
e-~ ~C ~
-_(s~_"~~--- . 19!~, and I reside at ~"'~O ;
(Street Number) ~ ~
FORT PIERCE, SAIN? lUC1E COUNTY, FlOR10A f a
:
and this statement is to be taken as my declaration of citizenship, actual tegal residence and domicile in the State of Horida. "
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(Insert here any pertinent facts, such as sale of property or business, or ~elinquishment of employment ~
~ ;
at former domicile, removal of family to new domicile, purchase of home, etc.)
i~S~ 1~~ ( 4
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~'r~-+~ ~ ~ ~ ~ 215814
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~ ~ ' ~U~~°J FILEd aN9 RECOR~ ~
st. WCIE COUi1TY f t
R4GEp POIT~1s ;
~ Cl•ERK C?KGUIT C011RT ,
ltfCOR~ YER~FIfO~~ '
$Er 2~ ~81M'1 ~ <
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1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
`I ftff~THER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~.3\~n ~ • \ ~O-~.~
~ (Name)
~
~ , ~ d` ~ V 2` t_
~ • (Address)
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~ Sworn.to and subscribed before me this 2~ day of~-~-~~~-~'`l , 19~.
~ ROGER POITRAS
K CIRCUIT OURT Notary Public
~c-~ ~
By D.C. My Commission e~;.:res
(To be executed in duplicate and origina: filed with Clerk Circuit Courf, and duplicate with Tax Assessor.)
soo~195 ~~E2127 ~
No. 13 -A
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