HomeMy WebLinkAbout1666 Declaration ot Domicile and Citizenshjp
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TO THE STATE AND COUNTY TAX ASSESSOR, ~
Sl. IUCIE COUNTY, FIORIDA: ~
This ~s my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accorda~ce and ~
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~n conformity with Chapter 222, Section 222.17, Florida Statutes. ~
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I was formerly a legal resident of - - _ - . _ _ _ _ _ _ - ;
(Ciry) tate) ~
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and 1 resided at ~~l ~ However 1 have changed my domiCule
( t~eet and Number)
fo and am and have been a bona fide resident of the State of Florida since i~~2~"' - day of
_ , 19~~_, and 1 reside at('lC~_~L~~ ~7~ l--L1__. ~c~--
(Street and Number)
FORT PIERCE, SAINT tUC1E COUNTY, RORIDA '
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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~O~ER PO?T COURT ~
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; RECO~e vc~ • ~-0 4
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~ I FURTHER CERTIFY ihat 1 will comply with all other requirements of a lega) resident of this State. ~
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~ 1 FURTHER CERTIFY that I have no intention to return to my former domiule, and I intend to remain in FORT i
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. [
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; •:~t{;' - (Name)
~ . { . ~'1''liC~a e ~ G'Ca'~ k
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~$1Nern~fo_~hd subscribed before me this day of - a , 19_L.j~
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ROGER POITRAS _ ~
CLERK CIRCUIT COURT Notary Public
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ti; By D.C. My Commission expires i
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(To be executed i~ duplicste snd ori~inal fil~d whh Cl~rk G~cuit Court, and dupliute with Tax Ass~ssor.)
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