HomeMy WebLinkAbout1912 ~ i :
DeClaration ot Domicile a~d Citizenship
TO TNE STATE AND COUNTY TAX ASSESSOR, ~1~8 f
51. lUC1E COUNTY, FLORIDA:
This is my declaration of Domicile an~ Citizenship in the State of ftorida that I am fiiing this day in accordance and
:n conformity w~th Chapter 222, Section 222.17, Florida Statutes.
I was fo~merly a tegal resident of ~
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~C;ty~ (State)
and I resided at . ~~l_ '~C _ 7 ~ { _ _ ~r _ _ Noweve~ 1 have changed my domicjle '
(Street and Number)
~o and am and have been a bona fide resident of the State of Florida sinte - day of ~
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C l~ 19_ and 1 reside at _ ~i~~~ t
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(Street an Number) ~ ~ '
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FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaraticn of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent fads, 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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S~~CIE COUitfY'~
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~ I FURTHER CERTiFY that I will comply with al) other requirements of a legal resident of this State.
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I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
~ PIERCE, SAIN~~UJCIE COUNTY, FLORIDA, permanently. ~
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(Name)
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~ Sworn to and subscr~bed before me this day of , 19
- ROGER POITRAS
'>a CLERK CIRCUIT COURT Notary Public
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By D.C. My Commission expires
(To b~ execut~d in dupliute and originsl ~ilsd with Cl~rk Grcuit Court, and dupliute with Tax Ass~ssor.)
°~~c198 n~1909 ~
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