HomeMy WebLinkAbout1691 Declaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR. 22162z ~
51. IUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in 1he State of Florida that I am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of ~~n[~r / /e~~.~~~n _I~ ~~~~r - -
(Gy) l ~l
and 1 resided at _ G': C__/ _ _ However 1 have changed my domiGile
(Street and Number) _
ro and am and have been a bona fide resident of the State of Florida since ~!L,G- - ~t-7~- day of
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- • 19--- , and I reside at _ _ ~'y~ ~-yy"~
(Street and Number)
FORT PIERCE, SAINT LUCIE Ct~UNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert he~e any pertinent facts, such as sale of properry or business, or relinquishment of employment f
at former domicile, removal of family to new domicile, pucchase of home, etc.)
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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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~ I FURTNER CERTIFY that I have no intention to return to my former domiule, and I intend to remain in FORT
~ PIERCF, SAINT LUCIE COUNTY, FLORIDA, permanently. E. ~EGORY HAWKIN ~
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~ S.wor~ tp a~d subscribed before me this day of - J ANK
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ROGER POITRAS -
CI CUIT COUR Notary Public
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By ~i O.C. My Comm~ssion expires
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='i (To be exscuted in duplicate and original ~iled with Cl~rk Circuit Cour~, snd dupliute with Tax Assessor.)
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