HomeMy WebLinkAbout2746 Deciaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
S7. LUCIE COUNTY, FIORI~A:
This is my declaration of Oom~cile and Citizenship in the State of Florida that 1 am filiny this day in accordanoe and
in oo~fa•mity with Chspt~r 222, Section 2?2.17, Floride Statutes.
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1 wa: formevly a legel reside~t of ~ ~ ~.?"ti~_ _ _ ~ ~1 ~J • _ ~
(Ci~j) (Staro)
and I resided ~t 0' ~r~ _ However I have tha m domiCjk
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(St~eet and Numbe~)
ro and am and have been e bona fide ~esider~t of the State of Flarida si~oe day of
0 ~Z 6 l~ .v-c ~
, 19~~, and 1 reside et ~ •
(St eet and Number)
FOR? PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declarasion of citizenship, actua! lefla) residence and domitile in the State of fiorida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishme~t of employma~t
st former domicile, romoval of family to new domicile, purchase of home, etc.) ~
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` • ST~IUCtf COUN'f~RfL~?~
ROCER POlTII?3 ;
- RECQR~ VERIf
EO C~u~t . .
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. O~c 13 02 I?N'11
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~ 1 FURTHER CEitTIFY that I will oomply with al) other requireme+~ts of a le~al resident of t1~is Stats. '
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~ 1'fllRTi~ER.CERTIFY that I have no intcntion to retum to my former domic~le, snd I intend to remain in fORT '
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~ PIERCE,~~;~'~1~~'NTY, FLORIDA, permanently. ~
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~ : A` . , _ss~+t.~~ J (Name) / ~ o~ ~i ~ ~ ;
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Swan to and subsuib~d befae me this ~ day of 19
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ROGER POtTRAS
- CIRCW~ COURT Notary Public
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gY d.C. My Commission expires
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- Ro b~ ~xeart~d in dvpliuh ~ed ori~inal fil~d witb C1~rlc Grwit Coue~, and d~plieal~ with Tax ll~ssor.) ~
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