HomeMy WebLinkAbout0520 Declaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~8.7V !
Sl. lUC1E COUNTY, FIORIDA:
This ~s my declaration of Domiule and Citizensh~p in the State of Florida that 1 am filing this day in accordance and
~n conformity with Chapter 222, Section ~22.17, Ftorida Statutes.
1 was formerly a legal resident of Cdn~ . ~
K;ty) (State)
and I resided at ~ ~~.G~~ _ However 1 have changed my dom6GG~e '
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(Slree! and Numbsr) ~
`o and am and have been a bona fide resident of the State of Florida since ~6Ti~/ • ~ day of
, 19._7~ , and I reside at ~s~~~ .(J ~!~[IL ~ _ - ~
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FtORIDA
and this statement is to be taken as my dec~aration of citizenship, actual legal residence and domicile in the State of Flo~ida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employme~t
at former domicile, re val of family to new domicile, purchase of h~me, etc.)
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of th~~ State.
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K I FURTHER CERTIFY that I have no intention to return to my former domic,ile, and I intend to remain in FORT i
~ PIERCE, SAINT IUCfE COUNTY, FIORIDA, permanently. ~
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(Name) ~
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Swotn fa ~nd subscribed before me this c/1__ _ day of ~'c.~:1r~_.. 19~. ~
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ROGER POITRAS ~
- CLERK GIRGUIT COURT ' Notary Public `
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8Y - y - -r L D.C. My Commission expires - - f
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= (To be sxecuted in duplicale and oripinal filsd with Cl~rlc Grcuit CouA, and duplicat~ with Tax ~ss~ssor.) ~
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~3 ~~R~ 197 Pa~E 520
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