HomeMy WebLinkAbout1539 Decia~ation ot Domicile and Citize~ahlp
TU THE STATE AND COUNTY TAX ASSESSOR, '
2~~.5~'7
Sl. LUCIE COUNTY, FLORIDA~
This is my dedaration of Dom~cile and Citizenship in the State of Flo~ida that 1 am fiting this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of _ ~~t~S!- - - -1~~~ddL ~2
(Ciry) (State) ;
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anrJ I resided at _ _ 30 _ ~,~1~. _ _ . However I have changed my domiCile - ~
f5treet and Number) ~
ro and am and have been a bona fide reside~t of the State of Florida since ~~S/~"L~ day of
- _ _ . _ 19...~~ . , and I reside at lI 0.3 ~ . G~~',z~G~~7_~'~n~:l.L`Q~ /~n~!~~
~ (Street and Number)
FORT PIERCE, SAINT LUCIE COtiNTY, 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 relinquishment of employment
at former domici!e, removal of family to new domicile, purchase of home, etc.)
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' F~~p A!1C ~ECORQEO !
' ST.IUC~E C~UNjY FU. f
' ilO~E"• FOITRAS ~
~ CtERK C' ~G £D COUR
~ RfCO~~ YE
~ a 3 02 PN'12
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€ 2~iSQ'7
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~ I 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 1 have no ir:tention to return to my former domic,ile, a~d I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanenNy. _ ~
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3 ~ ~ ' ~ ~ ~ t.-C,~ a~.c ~
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_ , • Name
~ ~ . ~R~~~R,~ m,~y,~R . ~
~ ~ ~ . - ~ ~ I ~ 90 3 _ ~E'u.~.~ ~~e,
' ~ ~ (Address)
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Sworn to and subscribed before me this da of _ 19 . ~
Y • -F~
= ROGER POITRAS _ ~
_ CLERK CIRCUIT COURT Notary Public ~
- By D.C. M Commission ex ires ~
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_ (To bs ~xx~ted in duplicat~ and ori~inal ~iled with G~rk Grcuit Court, a~d dupliut~ with Tax Assessor.)
saox198 ~~i537 ~
_ No. I 3 q