HomeMy WebLinkAbout1648 _ • Declaration ot Domi~ile and Citizenshlp
10 THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA: ~
This is my declarat~on of Domicile and Citizenship in the State of Flo~ida that 1 am filing this day in accordance and
~n conformity w~th Chapter 222, Section 222.17, Florida Statutes.
I was formerly a leqal resident of li4~~-~f~ !_1___ _ _ _.YI ~--~i'1--~L-I R_-
(City) ~ (State)
and 1 resided at ~ J ~a ~ K ~i~ ~ Z-- However I have changed my domicjle
(Street and Number)
to and am and have ueen a bona fide resident of the State of Florida since _ _ day of
A itTN u. ~?t S?20,1 ~
~Q 1l ~0 , 19.7I , and I reside at _ d~r2~ ~y~~_
~.--t?~a,--~ '
iStreet and 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 properry or business, or relinquishment of employment
at former domicile, removal of family to new domicife, purchase of home, etc.)
221595
FILED ANO RECORpEO ~
ST. LUCIE COUN?Y fLA.
,
' ROCE~ PO~TRAS
CLE~tK C:nCUtT COURT
RECORD Y~RIFIED~~,
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; 1 FURTHER CERTIFY that I will comply with al) other requiremenis of a legal resident of ihis State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in FORT
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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Y; {Name)
Kf
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P, D, t~ a~ 2~. ~,s
A_ d~-r~.t u R.S_. ~Q.
(Address) f "T, P~ ~ ~ ~ FL A,
Swom to and subscribed before me this - day of ' , 19_~Z
~
ROGER POITRAS _
CLERK CIRCUIT COURT Notacy Pu~ ~ ~ ~ ~ ~
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" aY - D.C. My Comrrussioh `ezprt~tt:~.t - - ~L . c.~..r~ f.
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(To be executed in duplicate snd orisinsl filed with Cl~rk Circuit Covrt, and dupliuts with Tsx Assessor.)
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