HomeMy WebLinkAbout2344 ~eclaration ot Don~icile and Citizenship
TO THE STATE'AND COUNTY TAX ASSESSOR. ~z`~~~ I
Sl. WCIE COUNTY, FLORIDA:
This ~s my declaration of Dom~c~le and Cit~zenship in the Sta~e of Florida that I am filing this day in accordance and
~n conformity with Chapter 222, Sect~on 222.17, Florida Statutes.
I was formerly a legal resident of ~'~~L~~~ - , -
~C;ty~ (State)
and I resided at 7~ _ '4! Nowever I have changed my domiGile
~~~r'~ (Street an Number) ~
ro and am and have been a bona fide resident of the State of Florida sinte ~`Q~ . - - day of
2 L-
_ ; 19~ f , and 1 reside at sl _ ' • . _
(Street and Number)
FORT PIERCE. SAINT LUCIE COUNTY, FLORIDA
and this statement is ta be taken as my declaration of citizenship, actual legal residence and domicile in the State of Flo°r~da.
(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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ftLEO Ay' RECORQE4
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i RECCSC~ VE-~ "t~~••••~,rs~?~•
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~ 1 FURTHER CERTIFY that I will comply with all other requiremenis of a legal resident of this State.
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~ 1 FURTHER CERTIFY that I have no intention to retum to my former domicjle, and I intend to remain in FORT
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PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently.
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- Swom to and subscribed before me this day of , 19Z_Z!
- ROGER POITRAS _ - _ -
CLERK CIRCUIT COURT Notary Public
By _ D.C. My Commission expires
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(To bs exscuted in duplicate and oripinsl ~iled with Cl~rk Grcuit Court, and duplicat~ with Tax Ass~ssor.)
~~K 1y8 P~~~~341
~4 '10 13
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