HomeMy WebLinkAbout1355 Declaratio~ ot Domicile and Citizenship ~
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FIORIDA: '
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This ~s my declarat~on of Domicite and Cit~zenship in the State of Florida that 1 am filing this day in accordance and
~n conformity w~th Chapter 222, Scction 222_17, Florida Statutes. +
I was formerly a legat ~esident of ROC~Ct!l1a~ New-sj~.L~~- -
~C;ty~ (State) ~
and I res~ded at . 3 II'Oq1110s ._A~Q_. However I have changed my domicjle }
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _ ~ it _ day of
_L~~~~m~er _ _ _ ~v_7_~ , and I ~es;de a, __4700_Oleander A~e.___
(Street and Number)
FORT PIERCE, SAINT 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.
(Insert here any pertinent fatts, such as sa(e of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc_)
Homestead Exemption
f~~EO PECOaoE~
~ ST.lUC1E COUMTY fLA.
~ lIOCE~i POITRAS
CLERl~ C~RCUIT COUR
~ RECORO VERIFIfD
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~ I FURTHER CERTIFY that I will comply with afl other requirements of a lega) resident of this State.
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q 1 FURTHER CERT{FY that 1 have no intention to retum to my former domiGle, and I intend to remain in FOR7
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~ PIERCE, SA1NT LUCIE COUNTY, FLORIDA, permanently_
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v~~' ; c~•''• - ~ (Name)
.g3 .s ~ ~ ~ ~ _ =
-s"~ ~ - ` ~ ~ r l~agnus S. Thorlakaon
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~ 4T00 Oleander ATe.
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Swom~to and subscribed before me this _'srd day of - nuar~__ , 19~.
- ROGER POITRAS
CIRCUIT COURT Notary Public
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y-~ By D.C. My Commission expires
(To b~ sxecvted in duplicate and original filed with Cl~rk Grcuit Court, snd duplicsts with Tax Assessor.)
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