HomeMy WebLinkAbout1812 Declaration ot Domicile and Citizenship 221~709
TO THE STATE AND COUNTY TAX ASSESSOR. • ~
Sl. lUC1E COUNTY, FIORIDA: ~
This is my declaration of Dom~cile and Citizenship in the State of Florida that 1 am filing this day in accordance and ~
~n conformity with Chapter 222, Section ~22.17, Florida Statutes.
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I was formerly a legal resident of _ 'L~ - -G2~---
~C~ry~ (State)
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and I resided at .~v ~ ~ __~(1 However 1 have changed my domicjle
(Street Number)
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ro and am and have been a bona fide resident of the State of Florida since _ _ f~_ day of }
- _ _ _ , 19~1 , and I reside at _1
~1--- - -
(Street and Number)
FORT PIERCE. SAINT LUCIE 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 ;
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at former domicile, removal of family to new domicile, purchase of home, etc.)
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FILEO ANO RECQR~EO
ST.IUCtE COUMTY FLA. ~
ROCER ~ O~TRAS
ClERK Ci~CUtt C0~!
RT
RECORD YE*.fF1E0
1 I i3 PH'72
~ 221'~09
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~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State. E
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~ I FURTHER CERTIFY that I have no intention to return to my former domiGle, and I intend to remain i~ FORT ~
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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- Sworn to and subscribed before me this day of , 19.L~
- ROCER POITRAS
K CIRCUIT COURT Notary Public
- By D.C. My Commission expires ;
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(To be sxecut~d in duplicate and ori~iR I~il~d with Ct~rlc Grcvit Court, and dupliuts with Tax Ass~ssor.) ~
- aoaK198 P~~~1810 ;
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- No 13
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