HomeMy WebLinkAbout1497 Declaration ot Dort~iclle and Citizenship
TO THE STATE AND COUNT'f TAX ASSESSOR, ~
51. LUCIE COUNTY, FLORIDA: 2~ ~~~1 '
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This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing fhis day in accordance and
~n conformity with Chapter 222, Section ??2.17, Florida Statutes. 4
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I was formerly a tegal resident of _ -
_ - -~Ciry) (State)
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3 7/ .~E~4% /C r ~ vc~ However 1 have changed my domiCu~e ~
and I resided at _ _ - -
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(Street and Number) '
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to ar~d am and have been a bona fide resident of the State of Florida since ~ y - day of
) _ O c/~ 30/ .C~.~AC~"E~ /1 OA -
~C j_ ~ , 19~1, and I reside at - _ - -
(Stre.~t and Number)
FORT PIERCE, SAINT LUCIE COUNTV, fIORIDA
and this statement is to be taken as my declaration of citizenship, actuat legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
iA~ a~:~ aECOROfO
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° 1 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 I have no intention to return to my former domiGle, and I intend to remain in FORT
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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(Name) ~
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Swom to and subscribed before me this day of - I , 19~~'
- ROGER POITRAS -
C CIRCUIT COURT Notary Public
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' By - _~2~ D.C. My Commission expires
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(To be executed in dupliute and original filed wkh Cl~rk Grcuit Court, and duplicats with Tax Assessor.) ~
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= a~ox 1y8 ~E 1495 '
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