HomeMy WebLinkAbout2798 Declaratio~ ot Domicile and Citizenship ~
TO THE STATE ANO COUPlTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FLORIDA: ~~0~ ~
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This ~s my deciaration of Domicile and Citizenship in the State of Fiorida that 1 am filing this day in accordante and
~n conformiy with Chapter 222, Settion 222.17, Florida Statutes.
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I was formerly a legal resident of _ . _ - - _
~C;ty~ (State)
and I resided at _ . However I have cha~ged my domic.ile
(St~eet and Number) /
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to and am and have been a bona fide resident of the State of Florida since ~~~~'t-~-L Y
,
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~ , and 1 reside at . ---~-1~ - - - _
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual 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 domicite, removal of family to new domicile, purchase of home, etc.)
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~ I FURTHER GERTIFY that I wil) comply with al) other requirements of a legal resident of this State.
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~ 1 FURTHER CERTIFY that 1 have no intention to return to my former domiule, and I intend to remain in FORT
~ ?tERCE, SAINT IUCIE COUNTY, FLORIDA, permanently_ ~
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- .±,5viorn-b end subscribed before me this day of - - . 19-~-~/
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- ROGER rO1TRA5 -
- C CIRCUIT COURT Notary Public
~ By -~~%~/C D.C. My Commission expires
~'a (To b~ ~xxut~d in dupliute and oriain~l fil~d with GKIc Cirtuit Court, and dupliut~ with Tax Ass~ssor.)
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