HomeMy WebLinkAbout2992 De~laration ot Domicile and Citizenship
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TO THE STATE AND COUNTY iAX ASSESSOR,
Sl. lUClf COUNTY, FLORIpA
This ~s my declaration of Dom~cile and Citizenship in the State of Florida that i am fil~ng this day ~n accordance and
~n conformity w~th Chapter 22~, Section 222.17, Florida Statutes
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I was formerly a legal resident of ; - -
t~~ty~ (State)
and I resided at ,7~,~ ~ 1~~/- ~ However I have changed my domicile
(Street and Number)
~o and am and have been a bona fide resident of the State of Florida since day of -
j ~7 , 19~z.~ , and t reside at ~ ~ ~ 6 `
~ (Street and Number)
FORT PIERCE, SAtN? LUCIE tOUNTIf, FLORIDA
and !his statement is to be taken as my declaration of citizenship, actual legal residence and domicile in ihe State of Florida.
(Insert here any pertinent facts, such as sale of property or business, ar relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
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X 1 FURTHER CERTIFY that ! have no intention to return to my former domicile, and 1 intend to remain in FORT ~
PIERCE, •SAINT LUGE COUNTY, FLORIDA, permanently. , ~
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{ Swor~ to a~d subscribed before me this _ day of~~"=""" 19~Z
ROGER POITRAS - - - - _ -
- CLERK CIRCUIT COURT Notary Public ~
- gY /'C.~-~-~-~_ D.C. My Commission expires
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- (To be executed in duplicste snd originai fileci with Clerk Ci~cuit Court, snd dupliuts with Tax Assessor.)
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