HomeMy WebLinkAbout1570 ~L
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~ Declaratio~ ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~1S~S •
S~ . LUCIE COUNTY, FIORIDA:
This is my declaration of Dom~c~le and Cit~2enship in the State of Florida that 1 am fil~ng this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of J~ U S~, _ !C_ c__lc---
(City) (State)
and 1 resided at Y I SO ~A ~ ~ A~v c~, S t_ _ _ However I have changed my domiG~e
(Street and Number) $
ro and am and have been a bona fide resident of the State of Florida since e _ day of ~
~t9 i11 , 19
~j and I reside at _ I v1 ? O_ ~ i I~J
~A/C.~ 1 V _ -
(Street br.d 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, o~ relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.) - -
FII,~ ~tlU Rf CL~tOfO ~
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1lO~E~ Fs~IT~AS
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~ I FURTHER CERTIFY ihat t will comply with all other requirements of a legal residenf of this State.
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~ i FURTHER CERTIFY that I have no intention to retum to my former domicile, and I intend to remain in FORT
~
s PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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ame) I~ r S.., ~c~e r' /i. <<J I',
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(Address~ :
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Sworn to and subscnbed before me this _,Z__ day of _lt-Yx r~ '
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ROGER POITRAS ~ t
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CLERK CIRCUIT COURT ~ ~ 3- .
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~F~; i_; "eG , - v,;
_ g _ . _ _ D.C. My Commission expires ' ` '
_ Y - ~ /D ~ y .<<~;
rt`~ (To be executed in duplicate and original filed w+th Cleric Circuit Court, and dupliuta w~~l. Tax Assessor.)
~;o „ booK 1y8 P~~t 1568
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