HomeMy WebLinkAbout1769 D~claration ot Domlcile and Citizenshlp ;
TO THE STATE AND COUNTY TAX ASSESSOR, ~~~c~~ •
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Sl. IUGE COUNTY, FIORIDA:
This is my detlaration of Dom~c~le and Citizensh~p in the State of Florida that 1 am filing this day in accordance and
~n conformiry with Chapter 22Z, Sect~on 222.17, Florida Statutes.
I was formerly a lega! resident of II t~-~_ _n~~.~-Q__ - L~
(City) (State)
/ G O i~F'r~oo /C /QY~
and I resided at , pt Z~~ . However 1 have changed my domici~e
(Street and Numbe~)
ro and am and have been a bona fide resident of the State of Florida since ~~f
K5~ _~O_ _ day of
- - , 19~1- , and I reside at 1~_?~O_~t y~~ r~ ~l'i vp ~~f Z_~ -
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my decla~ation of citizenship, actual legal residence and domicite in the State of Florida.
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(Insert here any pertinent fads, such as sale of property o~ business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
~G~ilf~c~.~F a ~`~CL~~t~ j/~~ ~i t/
fIIED AKD RECORDEi.
ST.IUCtE COUNTY FIA.
ROCEh P017RAS
CIERK t: :CU1t CO !~t
a~ceAz 1~~.*~f0
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1 FURTHER CHtTIFY that I will comply with all other requirements of a legai resident of this State.
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~ 1 FURTHER CERTIFY that 1 have ~o intention to return to my former domiCile, and 1 intend to remain in FORT
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~ PIERCE, SAINT LUClE COUNTY, FLORIDA, permanently.
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~ ~ ~.~-i ~ ~ ~ ~Name)
~ , _ ~GN E!~ SI+~1TN
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~ , ~ /3a~ s`trir~ Dz, rF /9t'f 20~ /`-~r~/-~~n'p
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Sworn to and subscribed before me this day of , 19~L~
- ROGER POITRAS
CIRCUIT COURT Notary Public
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gy U.C_ My ~ommission expires
(To be sxecut~d in dupliuN and oripinsl filsd witb Cleric Grwit Court, and dupliut~ with Tax Assesso?.)
_ ,3 ~1y8 ~17fi7
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