HomeMy WebLinkAbout2090 r
Decl~ration ot Don~icite a~d Citizenship
TO THE STATE AN~ COUNTY TAX ASSESSOR. .221899 ~
51. LUCIE COUNT~FLORiDA:
This is my detlaration of Dom~ciie and Citizenship in the State of Florida that 1 am filing this day in eao~dante and
~n conformity w~th Chapter 22~, Section ?22.17, Florida Statutes._
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I was formerly a legal resident of
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and I resided at i~y~~~~'~'~-- - However I have cha~~ged my domivle
~ (Street aRd Number)
fo and am a~d have ~een a bona fide resident of the State of Florida since day of
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- - - - - _ , 19 7~_ , artd I res~de at - -
(Street and Number)
fORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, aduat 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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ST.LUCfE COUNTYF~A.
ROC_n P~~TRAS
CtERK CIACUIT COURT ~
REGORC YE~:F~Er~
J~ I I 12 ai PM '7t
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~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
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~ 1 F13RTHfR CERTIFY that I have no intention to return to my former domic,ile, and I intend to remain in FORT
~ PIERCE, SAINT ~,UCIE COUNTY, FLORIDA, permanently.
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Sworn to and subscribed before me this day of f , 19 7~~ ~
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ROGEA POITRAS - .
" CI.ERK CIRCUIT COURT Notary Public
';t By ' rn~ D.C. My Commission expires
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(To b~ ex~cuted in dupliute and orisinal fil~d with C{Kk Grwit Court, and duplicat~ wifh Tsx Asseswr.)
,,o ,a BCOK~t7~ FAGE~U01
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