HomeMy WebLinkAbout0244 L/ i
DeClaratio~ ot Domlcile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl . LUCIE COUNTY, FLORIDA: ~ I O~
This is my declaration of Uomicile and Citizenship in the State of Flo~ida that I. am filing this day in accordance and
in conformity with Chapter 22~, Section 222.17, Florida Statutes.
I was formerly a legal resident of _ _ - _ . ,
(City) (State)
,
and I resided at _ _ However i havechanged my domiCile
(St~eet and Number)
to and am and have been a bona fide resident of ihe State of Florida s~nce _ day of
~ / ~ r- .
- - - (v~~G` - _ _ , 19~1, and I ~eside at -L_? 'S-- - ~ - -
eet and Number) ~
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declarat~on of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as se!e of property or business, or relinquishment of employment `
at former domicite, removal of fam~fy to new domicile, purchase of home, etc.) '
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FIlEO AlIU REZOROEO
ST.~uC~E ~ouNrr f~A.
R4G~~ r~,~TRAS
CIERK Ci: i,W ~ COURT/~c ~
RF~~a;t y«!F!f~~..~..L~~
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¢ I FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
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~ I FURTHER CERTIFY that I have no intention to retu~n to my former domitjle, and I intend to remain in FORT
~ PIERCE, $A~c1Y!1T•4l1CIE COUNTY, FLORIDA, permanently_
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~ ;•~,Sg ' % (Name)
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Sworn to and subscribed before me this f day of ~ , 19~~
-
- ROGER POITRAS
- CLERK CIRCUIT COURT Notary Public
~y D.C. My Commission expires '
:r~ (To b~ executed in duplicafe and oriqinal filed with CI~?k G?cuit Court, and duplicat~ with Tax Asses~or,) ~
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