HomeMy WebLinkAbout2720 y'
DeClaration of Domicile and Citise~ship
TO THE STATE ANO COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FIORIDA: ~~,35~
This is my declaration of Domiciie and Citizenship in the State of Florida that 1 am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Stetutes.
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I was formerly a legal resident of _ _--(k'S'~1"+!`-- - - - - - -
(City) (Sta e) ~
and 1 resided at (.e'G~G~. _ Nowever 1 have changed my domiCile
(Street and Number)
fo and am and have been a bona fide residertt of the State of Florida since day of
~r ~
- 19 ~l and I reside at Y~1 _
' (Street and Number)
° PORT PIERCE, SAINT LUCIE COUNTY, RORIOA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
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(Insert here any pertinent facts, such as sale of property or business, or retinquishment of employment ~
at former domicile, removal of family to new domicile, purchase of home, etc.)
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' ~,w4 REGgR~I~-
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_ ~~.lU CR r~~~RA9
~ ROG~ ~.,i0t1 GO~R~
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I FURTHER CERTIFY that 1 will comply with all other requirements of a leya) resident of this Stnte.
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~ I FURTHER CERTIFY that I have no intention to retum to my former domicjle, and 1 intend to remain in FORT
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~ FIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_
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. 'a!. (Name)
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. : ti- 7? . ~ • )'1'ta~-~•?.oa.c-~
` s = ~ (Address)
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: ~ J Sworn to and subscribed before me this ! day of - - . 19~?~
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- ROGER POITRAS
CLERK CIRCUIT COURT Notary Publit
~Y-~ gy ~.CL._~. D.C. My Commission expires i
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~''v (To be ~xecvt~d in dupliute and ori~inal ~iled with Cl~rk Grcuit Courf, snd dupliuts with Tax Ass~s:orJ
~ $o~Ki98 ~~2717 ~
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