HomeMy WebLinkAbout1149 Declaration ot Domicile and Citize~ship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FIORI~A:
219~33
This is my decla~ation of Domicile and Citizenship in the State of Florids that I am filing this day in sccordance and
~n conformity with Chapter 222, Section 222.17, Flo~ida Statutes.
I was formerly a legal resident of ~~.~-=-~~i--- - -
~C~ty~ (State)
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and I res~ded at ,,,,:'~L.1.~ - Howev 1 have a ye~jmy domitile
(St~eet and Numbe~) ~t,~ _ '
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to and am a~d have been a bona fide reside~t of the State of Florida since _ ~ day of
-~-'~`~L----- 19~~1 . and I ~eside at l .~,'~J~'C2 ~P _PC'~~; : ~/1"'~
(Street a~d Number)
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FORT PIERCE, SAINT LUCIE COUNTY, PLORIDA
and this statement is to be taken as my deciaration of citize~ship, actuai lega{ reside~ce and domiciis in the Slate of Fiorida.
(Insert he~e any pertinent facts, such.as sale of property or business, or relinquishment of emr~oyment
at former domicile, ~emoval of fam~~Y to new domicile, purchase of Fwme, etc.)
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~ s?.l1iC~E COUMT'~ PU.
; pOCER POI~RAS
~ CIERK C1RC111t ~01~T v
~ RECORO VER~f1E0
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~ 21933 3
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~ 1 FURTHER CERTIFY that I will comply with all other ~equirements of s leyal resident of this St~te.
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I FURTHER CERTIFY that I have no intention to ~eturn to my forme~ domiule, and I intend to remain in FORT
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~ PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanentty. ~ . J '
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SwornYo and subscribed before me this ~ day of J°~ l` . ~9~•
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- ROGER POI?RAS
C~ERK CIRCUI~~OURT Notary Pubiic
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~ 1 By a<<<. G ~-~~L l~~ D.C. My Commission expires
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- ~ (To be sxocuted in dupliute and original filed with Gtrk Circuit Court, and duplicate with Tsx Ass~swr.)
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