HomeMy WebLinkAbout2087 DeClaration ot Domicile and Cltisenship ~
TO THE STATE AND COUNTY TAX ASSESSOR,
51. WCIE COUNTY, F~oR~oA: 2~1896 i
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This is my declaration of Oomicile and Citizenship in the State of Florida that 1 am filing this day i~ accordance and ~
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~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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I was formerly a legal resident of C~t
(Ciy) t te) s
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and 1 resided at ~ - G'~/ - ~ • _ ^9 Y
(Street and Number) _
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to and am and have been a bona fide resident of the State of Florioa since - - day of
- - _ _ _ _ , 19~/ , and I reside at -__~_L~_~ • -e~~~` ~ - - - - -
(Street and Number)
FORT PIERCE, S INT lUC1E COUNTY, FtORIDA
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 _
at former domicile, removal of family to new domicile, purchase of home, etc.)
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lED AKO RECOiip~
:~~.ltlClE GOUMTY F~. t ;
ROGEF PO~TRIIS ~ ;
CIERK Cl3CWT COURT ;
RECOR~ VER~f'ED
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F 221896
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~ I FURTHER CERTIFY that I will comply with all other requirements of a lega) resident of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domicrle, and I i~tend to remain in FORT
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~ PIERCE, SAINT LUCIE ~OUNTY, FLORIDA, permanently.
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;x _ ~ (Name) f/~E ~'Z
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= Sworn to and subscribed before me this --11-- day of , 191---~
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ROGER POITRAS -
rc CLERK CIRCUIT COURT Notary Public
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By _ ~ D.C. My Commission expires
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u~: (To be executed in duplicat~ snd oripinsl filed with Cl~rk Grcuit Courf, sed dupliat~ with Tax Ass~ssor.)
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