HomeMy WebLinkAbout1353 Declaration o! Domicile and Citizenship ~
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA~ ~G~M13'79
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and ~
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~n conformiry w~th Chapter 222, Sectio~ 222.17, Florida Statutes. ~
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I was fo~merly a legat resident of ~ ~~_C- ~G_v__._ _ _ _ _ _ - ~
(City) (State) ~
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l~ ~j ~~~1Qi( ~ / Howeve~ I have changed my domic,ile ~
and 1 resided at - -t-~--- --1-T~'----- }
(Street and Number) ~
ro and am and have been a bona fide resident of the State of Florida since T~- - day of ~
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C. - , ~ 9-- , ~ res~de at l ~ _ _ - ~
(Street and Number)~ ~
FORT PIERCE, SAtNT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Inse?t here any pertinent facts, such as sale of properry or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
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~ I FURTHER CERTIFY that 1 have no intention to return to my former domiCGle, and 1 intend to remain in FORT
~ PIERCE, SAINT LUUE COUNfY, FLORIDA, permanently.
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•SWDfR'iq.and`subscribed before me this ~ day of . 19~•
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° ROGER POtTRAS -
= C K CIRCUIT COURT Notary Public
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gy _ D.C. My Commission expires
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: (To be ex~cuted in duplicste snd original fitsd with Ct~rk C'ircuit Court, a~+d duplicate with Tax Assessor.)
~o~~i98 ~1351
'=~'-s No 13 A