HomeMy WebLinkAbout0461 u~
. ,
Declaration ot Domicile and Citizenship ~
TO THE STATE AND COUNTY TAX ASSESSOR, ~22853
Sl. LUCiE COUNTY, FIORiDA:
ihis is my declaration of Domicile and Citiiensh~p in the State of Florida that 1 am filing this day in acco~dance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of - -
- (City) (State)
/ ` .
and i resided at J~_ ~1'~ _ However I have changed my domic,ile
~ (Street and Number)
ro and am and have been a bona fide resident of the State of Florida since _ c~!O day of
~j /
- - _ . 19~ , and I reside at ~c' - - - -
(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 ihe State of Florida.
(Insert here any pertinent facts, such as sale of p~operty or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
~ •-~'~j'C~
'~~i
,
~
~FILEO ItND RfCOFi~
~T.LUCIE COUNTY?~LA.
' itOCE~ ~OITRAS
~ Rf.CdRO V~F~f ~o
c°~ ~
I
€ ~i~w ~l 3 ~ PM'~Z
~
C
3
{
a
s
~ 2~2853
~
i
~ .
!
i
~
~
£
i
~
~ i FURTHER CERTIFY that I wilt comply with al) other requirements of a legal resident of this State.
~
~
~
~ I FURTHER CERTIFY that 1 have no intention to return to my former domiule, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~
~
~ ,
~ ~~~~~ta~u~tiq~~ ~ , _
~ •'~(~131T'°:- fi~~~ ( )
- ~ j;~ N
;
~ ~ • •U .~G - ~
f~ •lj
~ i~`s~~-`
_ f 1`'~'~~ ~ - * r ~ Q ~ ( ~ ~ •~.r
_ l - # ; - @55~
. .
.
; :~~~'f'~.7,•=
t ~
r~ '~w~nwf~~d`~~iscn'bed before me this day of - , 19~'
4.... ~~t,~
ti~ i :
: `
" ROGER POITRAS
LERK CIRCUIT CO RT ~ Notary Public t
"~J t
6y ` D.C. My Commission expires
~
- (To bs executsd in duplicate and originsl ~ilsd with Cltrk Ci~cuit Court, and dupliute with Tax Assessor.)
`'"~y ~:a 13 ECRK199 P~!'E '4~