HomeMy WebLinkAbout1631 Declaratio~ ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, 2;~1~1
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Sl. LUCIE COUNTY, FLORIDA- ~
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This is my declaration of Oom~cile and Citizenship in the 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 formerty a legal resident of ~ ~0/7 _ ~lt~ . _ _ - - l- ;
(C;y) (State) `
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and I resided at ~_G~%~SOt1 /QV l.° f1P[[t!~ s~'! `L However I have changed my domiCile
(Street and ~umber)
to and am and have been a bona fide resident of the State of Florida since - r- daY 4f
~.1GL_t?_ , 19~~, and I reside at ~'~0 `~k~~~f ~ !'rf ~'~4'Gt~
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FlOR10A
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 domicile, removal of family to new domicile, purchase of home, etc.)
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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 I have no intention to return to my former domiule, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~:`'~;J~~- C'`~~i,~`'- (Name) .
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. =$w~~~ to,ptitd subscribed before me this ~ - day of ~ t , 19~'`-„
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ROGER POITRAS - -
CLERK CIRCUIT COURT Notary Public
gy L~~~~{ D.C. My Commission expi~es
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- (To be executed in duplicate and original filed with Cl~rk Grcuit Court, and duplicats with Tax Assessor.)
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