HomeMy WebLinkAbout1644 De~iaration ot Domi~ile and Citizenshlp
TO THE STATE AND COUNTY TAX ASSESSOR, ~
22159~
Sl. IUCIE COUNTY, FIORIDA:
This is my declaration of Dom~cile and Citizensh~p in the Stare of Florida that I am filing th~s day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes_
;
I was formerly a legal res~dent of ~CJA~-QR~~ __~L~.__ `
(Ciry) (State) ~
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and I resided at '~Z Z~ W~_~ 7 S~~T Ls _-__.I1I~~Y~_ _ However 1 have changed my domiCile
. (Street and Number)
ro and am and have been a bona fide resident of the State of Florida since ~d N~ . day of
, 19~ l, and t reside ar 7_ - i
(Sireet a~d Number) ;
. ;
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA ~
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and this statement is to be taken as my declaration of citizenship, actual legal reside~ce and domicile in the State of Fl~rida. !
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of emptnyment ,
at former domicile, removal of famiiy to new domicile, purchase of home, etc.)
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~ I FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State. T
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n I FURTHER CERTIFY that I have no intention to return to my former domicGie, and 1 intend to remain in FORT }
~ ;
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~ PIERCE, SP.INT lUC1E COUNTY, FLORIDA, permanentiy.
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(Address)
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~ Sworn b and subscribed before me this day of ' ~_~c~_ , 19~?~;
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= ROGER POITRAS ~ - - '
C K CIRCUIT COURT Notary Public ~
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= BY ~371= ~ ` - D.C. !Ay Comr;~~ssi~n ex~ires " -
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(To be axecuted in duplicate and original filed with Clark Circvit Cou?t, and dupliute with Tax Assessor.) i
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# do~198 ~?~~.~4~ ~
No 13 A