HomeMy WebLinkAbout2616 Oeclaratio~ ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~~~83 ~
51. LUCIE COUNTY, FLORIDA:
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Th~s is my declaration of Dom~cile and Citizensh~p in the State of Florida that I am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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1 was formerly a legal resident of Qf~ - ($tete)
(City)
and I resided at S~.~~~ ~-r--Ll ~ Nowever 1 have changed my domitilc
(Street and Number~
to and am and have been a bona fide resident of the State of Florida since ~_~C- 4' Q~-~- l--~ day of
19--_ , and I reside at .~~~_--~.4.-!~~/~ - -
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(Sl~~t ~!u~ N~~?r+L~erl
FORT PIERCE, SAIN? tUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, act~al 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.)
aT
wc~F c~uMTr Fi~ ~
R06ER A3iTRAg
CIERK CtnCUIT COURT
. RECQRO V~:,;F;EO
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_ ~22~83
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ti f FURTHER CERTIFY that I will comply with all other ~equiremeMs of a legal resident of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domic,ite, and I inte~d to remain in FORT
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` PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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' ~ . (Name)
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"Swc3tn• o b~rid subscribed before me this ~ d day of ~ . 19~Z~
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- ROGER POITRAS - -
= CLERK CIRCUIT COURT Notary Public
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~;:y~ gy D.C. My Commission expires ;
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Y~-~ (To be execut~d in dupliute snd ori~inal filsd with Cl~rk Grcuit Court, and dupiisaN with Tax Ass~sso~.)
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