HomeMy WebLinkAbout1649 ~
~21596
Dec~aration ot Domicile
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TO THE STATE AND COUNTY TAX ASSESSOR,
5~ . LUCIE COUNTY, FLORIDA: !
This ~s my declaration of Dom~cile and Citizenship 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.
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I was formerly a legal resident of ~1~ D ~O/1~~! .__.l_!-'- 5~--_-- -
(City) (State)
and 1 resided at ~ Q~? N v R~+ ~~'1 _-.A.~IL However I have changed my domicjle
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _ _ day of
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~ 1R`'~ , 19~ ~ , and I reside at I.J_ fJ ~C_ ~ . -
(Street and Number}
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual lega! residence and domicife 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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221596
flLEO Ah~ RECDR~
SZ_ LUCIE COUNTY ~
~ RQCER POITR~S
; CIfRK CtRCU1T COURT
RECOR!' Vi.N'fIEO~..~ ~
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~ I FURTHER CERTIFI( that I will mmply with all other requirements of a legal resident o~ this State.
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~ I FURTHER CERTIFY that 1 have no intention to return to my former domiule, and 1 intend to remain in FORT
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~ PIERCE, SAINT LUCIE COUNTY, FIORIDA, penranently.
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~ (Name)
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1~~ a ~-s~ , ~Th ~ ~e ~,r l~ -
(Address)
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.3 Swom to and subscribed before me this day of , 19.L__~
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ROGER POITRAS _
CLERK CIRCUIT COURT rfotary' Publ'
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9Y D.C. My CdT~~ssion expi~s_ ~ ww r w. a c...r. cw j
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(To be executed in duplicate and original ~iled with Cl~rk Cirprit Court, ahd dupFcat~j wiM~ Tax Assessor.)
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