HomeMy WebLinkAbout1538 s
Declaration ot Domicile and Citizenship
~ ~
TO THE STATE AND COUNTY TAX ASSESSOR,
#
Sl. LUCIE COUNTY, F~oR~oA: 2~i50f, t
This is my declaration of Oomicite and Citizenship in the State of Florida that I am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Flo~ida Statutes.
~ • i
I was formerly a legal resident of ~l1_~e4i_ _ ~a~G~N~Ql
. ~ - - - - -
(City) (State)
- ~ `'l i
and I resided at :3! ~__3 However I have changed my domitile
(Stteet and Number) ;
to and am and have been a bona fide resident of the State of Florida since da of
_ - -f
s~ f - Y ~
_ _ _ . _ _ 19-_ . , and I reside at
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, ~LOR1~A
and this statement is to be taken as my declaration of citizenship, adual legal resid~nce and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employme~t
at forme~ domicile, removal of family to new domicile, purchase ot home, etc.)
/ ~ri,E~iu?~ ~.£CORB£~
~
ST_littlF C3ttMiT F1~. p?
~iiCi R - Oi tRAi ( ~
tc~+c r+;,cu~t t+~tt
RFCt+P~ rE= S~~ED ~
.M~ ~ 2 S8 PM'~Z
f 2~isos
~
;
~
!
~
i
3
i
i
r
a
`a
~
~ I FURTHER CERTIFY that I will comply with all othe~ requirements of a legal resident of thia State.
~
x
~ I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and 1 intend to remain in FORT
~
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. _
F
y .
. : , r'j,~~• ~ ~ .
" ' !.r~'` (Name)
~ ~ ' f`~~^ .
` ~ ~
`i ? R i / ~
. ` = ~ (Address)
3; . .
- ~ _'x . /
`'Sworn to and subscribed before me this _ day of , 19 7 v
" ROGER POITRAS
'rj
CLERK CIRCUIT COURT Notary Public '
~
,
' By D.C. My Commission expires
« , -
r-= (To bs •xscuhd in dupliuM snd ori~inal ~ilsd wifh Cl~rk Grcuit Couet, and duplicat~ with Tax Ass~ssor.)
'4.i ~p
~ 13 600K1~0 PAGE1t~,h~V
_
-