HomeMy WebLinkAbout0231 1
Declaratio~ ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, %I;NV1~r~~ 1.
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51. LUCIE COUNTY, FIORIDA:
This is my detlaration of Domicile and Citizenship in the State of Florida that I am tiling this day in accordance and ;
~n ccnformity with Chapter 222, Section 222.17, Florida Statutes. ~
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1 was forme~ly a legal resident of ~~1f'rES~VR G__ ~'s'__ TtRSL~
(City) (State)
and 1 resided at ~l _ L.~ ~ U I~~ - j'A'Nr- _ . However 1 have changed my domitile
(Street and Number) ~
to and am and have been a bona fide resident of the State of Florida since -~~TX day of +
t1~ • _%L_ __~~'_~Lo~rsr~ DRr~
p _ _ _ , 19~ ~ , and I reside at 7 - - - -
(Street and Number)
F{?RT PIERCE. SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Inser; here any peftinent facts, such as sale of property or business, or reli~quishment of employment
at former domicila, removal of family to new domicile, purchase of home, etc.)
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fItED Al+= REC~ROE~
' St.LdC1E C0I311T11 fi~-
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~ C~ERX C.?CU!7 COURT ~t~
~ Af~CR41 V~ }<~~~ED
~11 ~~J ~1 56 ~'7Z
222690
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~ I FURTHER CER7IFY that I will comply with al) other requirements of a lega) resident of this State.
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~ I FURTHER CERTlFY that 1 have no intention to return to my former domic,ile, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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•~~i.; '••.,d~~~~~~ / (Name) ,V A1Qp
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~'`Sw,p~n. ta,and subscribed before me this day of { . 19~L
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ROGER POITRAS -
= CLERK CIRCUIT COURT Notary Public
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By U.C. My Commission expires ~
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.(To be sxecu»d in duplicate and original file~ with G~rk Circuit Court, snd duplicah with Tsx Assessor.)
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