HomeMy WebLinkAbout2350 y~
~eclaration ot ~omicile and Citizenship
TO TNE STATE AND COUNTY TAX ASSESSOR, ;
222081
Sl. LUCIE COUNTY, FIORIDA:
This ~s my declaration of Dom~cile and Crtizensh~p in the State of Fiorida that 1 am filing ihis day in atcordance and
~n conformity with Chapter 22?, Section ?22.17, Florida Statutes.
I was formerly a legal resideM of ( Mv~~-~~~__ _ ~la-t^_~'~!'-'~
(City) (State)
and 1 resided at _ ( Q~Q ~ w-`~C s: et~ V'____ _ However I have changed my domicjle •
(Street and Number)
To and am and have been a bona fide resident of the State of Florida since ~t by+~~• f~ 3 _ rlay of
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~tr , 19 7~ , and I reside at 30y ~ Qvc'/lrro~tS_~~_~/'o~T~_~~i : t~ f'l.
{Street and Number; ,33 °IS~O
i-~iti PiERCE, Sr~i~ifi LUCiE COUNTY, FLORiD~?
and this statement is to be take~ as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Inser? here any pertinent facts, such as saie of property or businzss, or relina~~ishment of empfoyment
at former domicile, removal of family to new domicile, purchase of home, etc.l
L Fi~ED AN: !'cG~JRO€R
~ 1~ h1 E S li c'< bt tUC~~ ~:=uMT~( f~~.
RUCE~ FOtT4A5
`=~n .;.'~!r rn~tt~F ll,. ~
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RECCRJ YE-~rtf0~
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~ I FURTHER CERTIFY that I will comply with all other requirements of a le~al res~~wnt of thia State.
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~ I FURTHER CERTIFY that I have no intention to return to my forme: domi~ile, and 1 intend to remain in FORT
4
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ !Name) q, q a E:
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= _ 3 O Y~ ovE i b. o~~4s___~.~__
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Sworn. to• and suburibed before me this day of - . 19
=(z ~
ROGER POITRAS -
CLERK CIRCUIT CO!!RT N~t~ry Public
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~ _ D.C. My Commission expires
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(To be sxecuted in duplicate snd originsi Tiieci with CI~?k Grcuit Cour1, and duplicate with Tax AssessorJ
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