HomeMy WebLinkAbout1484 De~laration ot Dottti~ile and Citizenship
TO THE STATE ANO COUNTY TAX ASSESSqR, ~
2~~4s4 ;
51. lUC1E COUNTY, FLORIDA:
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Th~s ~s my declaration of ~omiciie and Citizensh~p in the State of Florida that I am filing this day in accordance and ~
~n conformity with Chapter 222, Section 222.17, Floride Statules.
I was formerly a legaf resident of 1~~.1 L1 U 1~ t~.__- -~e~~`g-~~~'~~
~C~ty~ (State)
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- 1 have changed my domic.ile
end 1 ICSIUCO ei _v~ ~ i s~._ ~~iiu~ "
(Streef and Number)
ro and am and have been a bona fide resident of the State of Florida since ~~.~~~t~'~.b~r _ day of
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- - ,3 . 19 7 1 . and I reside at ~_l.'Y _ Il~ ta i s~9 ~ l~ ~S+_(~2~~.T _ ~
(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 facts, such as sale of property or business, or ~elinquishment of employment
at former domicile, removal of famiiy to new domicile, purchase of home, etc.)
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'ANO RE~ORQED i
S~CI£ COtNtTYr1IlAA-
qotOQFF. POtTRAl~~
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` 2~1464
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~ I FURTHER CERTIFY that I will comply with all other requirements of a legrl resident of this State.
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~ 1 FURTHER..CERTIFY that 1 have no inte~tion to return to my former domiu~e, and I intend to remain in FORT
~ PIERCE, SA~rNT~LNIG.i,~,~COUNTY, FLORIDA, permane~tly.
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Sworn to and subscribed before me this ry day of ~ . 19~• ~
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ROGER POITRAS ~
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_ tFttK CIRC!!IT COURT Notary Public
= By D.C. My Commission expires
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_ (To be exscuted in duplicate and ori~inal ~iled with Clerle Grcuit Court, and duplicate with Tsx /1ss~ssor.)
=N rio i 3~, Q~OK ~ 1482
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