HomeMy WebLinkAbout1513 ~ / ~
Declaration ot Don~icile a~d Citizenship ~
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FlORIDA: ~a~v ` {
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This is my declaration of Domicile and'Cttizenship in fhe State of Florida that 1 am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes. ~
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I was formerly a legal resident of _ . ,~~~"'d~~~!~-'~.-- - - - - ' - -
~C;tyj / State)
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and I resided at ~ _ _ _ _ ' _ _ _ _ _ . However I have changed my domic.ile
(Street and Number)
to and am and have been a bona fide tesident of the State of Florida since ~/~~~-ti - day of
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, 19~~', and I reside at ~ l _ ' - -
~ ~ (Street and Number)
:3~T S~it~ST LL'~:~ CCiS3~~, ~~t2~:t?A
and this statement is to be taken as my declaration of citizenship, actual legai 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.) ~
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ST.IUCtE .~SNTY FIA.
R~~LZ ,-~~,tRAS C~
CtfFK C~~{CUIT COUftT
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= rvR~~~R ~.c~c~~r~'i ino~ t iiVin Ca3~i~j~~jt Wi~n a~~ c34~~at PeyiiiJ@~iici~45 ~ o~cya icSiuan~ v~ ~~~~a .,~a.c.
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~ I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ^
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~ ;~r- , (Name) ~ - JYt/SaN
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T Jwo~n fo and subscribed beiore me ihis aay oi , i9 1~
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~ ROGER POITRAS -
CLERK CIRCUIT GOURT Notary Public
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~x3 By ' ~ (1L~_ D.C. My Commission expires 1
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(To be ~xscuted in duplicate snd ori~inal ~iled with Cle~ic Circuit Cour?, and duplicat~ with T~x Assesso~.)
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a oK~.98 ~~15~1 i
No. 13 A
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