HomeMy WebLinkAbout2854 D~claraYion ot D~micil~ ana Citii~en:.:.~;~
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TO i HE JIATE AND C~UNTY TAX ASSc~SOR, '
~l. LUC:IE COUNTY, FLOFIDA:
~n~s ~s my declarar~on oi Qom.uie o~1d C~t~z~nsh~p rn ths ~tate of F{orida that 1 om fii~ng tn;s day in accordance and
,n conform;ry w+th Chapter 222, Section 222.1~. Florida Statutes.
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I was formerly a?ega! resident of p.
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(City) (Stare)
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and ! residecS at 7~_11~'~~ .f'_ 1_ ~L_ ~.~.L.~~___l~-~~_t~t~..--- _ Hcwever I have changed my domi~i;e
(Street and Number}
~o and am and have been a bona fide resident of the State of Florida since _~/~~_l~ I_ ~T Zl_ day ot
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, i9-_ . and 1 reside at ~L 1_~~~_ ~~L ~ l ~.~2 I'n~? ~ r' ~L~'t/' _ _
- - - (Street and Nu .ber)
~ORT PIERCE, SAIN7 LUGE COUNTY, fLORIDA
and tnis s:atement is to be saken as my declaration of citizenship, acsua{ legal resi4ence ar,d domicile in the S*ate oi Florida.
~ (Insert here any pert~nent facts, such as sale of property or bus~ness, or reiinqu~shment of employn:ent
~ at former domicile, removal of family to new domicile, purc;~~se of home, etcJ
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I FJRTN:R CERTIFY that I wii! com~fy with all oiher requirernenss of a legal resident o~ t'r•.:s State.
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~ I"ruR t F:t2 C"tRTlrY tnat I have no intention to retum to 'rc~y forrnet domi~;:e, and I intend to remain ~n "rORT
~icRC,:, SAINT t:iC1E COUNTY, FiORlDA, permanently.
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~ Svyorrt to.artd subscribed before me this ~ day of ~ , 19_7!_.
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ROGER POITRAS - - - - i
_ CLERK CIRCUIT COURT Nota:y Pu:,iic ~
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- ;,Y ~ fj~ ~c /~1-~_~_~ D.C. My Comm:ssion exp;res -
(7o be oxocuted in duplicate and original filed with Clerk Gircuit Court, and YV`.~~~.~:e with Tax AssQSSOr.)
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