HomeMy WebLinkAbout1808 ~
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Deciaratton ot Domicila and Citizenship :
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TO THE STATE AND COUNTY TAX ASSESSOR, ~~~~nc
Sl . lUClE COUNTY, FlOR1~A: V V
This is my declaration of ~omicile and Citizenship in the State of Florida that I am filing this day i~ acco~dance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
~ ~~G~ ~vois
1 was formerly a legal resident of . _ _ -
(Ciy) . (State)
and I resicied at _~~ao~ ~U N~EI~SIIJ ~'yE• However 1 have changed my domiCi~s
(Street and Number)
to and am and have been a bona fide resident of the State ot Florida since _l~ P~ 19 7~ day of
197~__, and 1 reside at ~Q~_ ~i w. ~azF~~~es~ a~__~'~L•
(Street and Number)
FORT PiERCE, SAIN? LUCIE COUNTY. RORIDA
and this stateme~t is to be taken as my decla~ation 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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RECO~tD VEP.!FtfD~~....FL'
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~ I FURTHER CERTIFY that I will oomply with all other requirsmenta of a lega) resident of this State.
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~ 1 FURTHER CERTIFY that I have no intention to return to my former domic,ile, and I intend to remain in FORT
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~ PIERCE, SAINT;LUC{E EOUNTY, FLORIDA, permanently.
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~y - ~ _ (Name)
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V` _ G~;, (Address)
Sworn to and subscribed before me this day of , 19~~!
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ROGER POITRAS ,
~ CLERK CIRCUIT COURT Notary Public
y:~ By D.C. My Commission expires
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'r~; (To be ~x~cut~d in dupliut~ snd oripinsl Rlsd wi~h GK1c Grcuit Court, and duplicaN with Tax Ass~ssor.)
~Y , s• 60CK 190 PAC~ 1S11U -
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