HomeMy WebLinkAbout1680 Declaration ot Domicile and Citizenship
TO THE STATE AN~ COUNTY TAX ASSESSOR, ' ~lc~~ ~
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Sl. tUCIE COUNTY, FIORI~A: ~
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This ~s my declaration ot ~omicile and Citizensh~p in the State of Florida that I am filing this day in accordance a~d ~
;n conformity with Chapter ?22, Section 222.17, Florida Statutes. ~
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1 was formerly a legal resident of _ _ _ . _ _ - - ~
(C;y) (State?
and 1 resided at _ However I have changed my domiCile
~ (Street and Number)
to and am and have been a bona fide ~esident of the State of Florida since Qi'j~' ~"1~~. _ day of
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_ _ _ _ _ _ _ , 19~1 _ a~d I reside at t~ C? ~ _~~~d't-°~(~1 al~
(Street 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 sa!e of property or business, or relinquishment of employment
at forme~ domicile, removaf of family to new domicile, purchase of home, etc.) ~
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fIlEO AH~ °ECs~OED ~
• ST. WCIC ~a~jt~R S ~A. •(j~
ROG" a • tr1\
CtERK L ~:CU~~ COURt V
RECO~D Y' ~EO
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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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~ 1 FURTHER CERTIFY that I have no intention to return to my former domiule, and 1 intend to remain in FORT
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~ PIERCE, SAINT 'U1CIE COUNTY, FLORIDA, permanently.
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~ - (Name) i
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' Swom to and subscribed before me this day of , 19...~~
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ROGER POITRAS _ ~
CLERK CIRCUIT COURT Notary Public
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- By D.C. My Commission expires
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(To bs sx~cutad in duplicate snd ori~inal filsd with Cl~ric Grcuit Cour1, and duplinM with Tax Assessor.)
~Q , 3 A 600K PACf I ~
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