HomeMy WebLinkAbout0520 oecia~ation ot Domicile and Citizenship 2;~2892
TO THE STATE ANO COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FIORIDA~ •
This is my declaration of Oomicile and Citizenship in the State of Florida thas 1 am filing this day in accordance and
~n conformity with Chapter ~~2. Section 222.17, Florida Statutes.
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I was formerly a legat resident of , -t - ~tiC~,/~L`~c- - ~ - -
~ (Ciry? (State)
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and I resided at _ Lv _ _ _ _ . _ . _ _ However I have changed my domiGile
(Street and Number) •
ro and am and have been a bona fide resident of the State of Florida since ~ S~_ day of
,
_ _ 2 N~
, 19-~( , and I reside at ! ~ ~ ~-1 -
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(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual iegal 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 domicile, removal of family o new domicile, purchase of home, etc.)
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FIIED ~kr. qECORDED
ST_ tUC~c ~pU1~TT F~A.
Re~~^ ~~iTRAS
RFCGRn ti•Cs~,'"UiT COURT
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J~ ~8 10 so AN'12
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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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~ I FURTHER CERTIFY that I have no intention to return to my former domic,ile, a~d I intend to remain in FORT ~
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ ~ S4 ~ R ^(Name)
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.S~erorrt tA.~ ~bstribed before me this _ ~ ~ day of --~~~~s~ , 19~2~
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~R ROGER POITRAS _
K CIRCUIT COURT Notary Public
~ By D.C. My Commission expires
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(To be sxecuted in duplicate and originsl ~iled with Clerk Grcuit Court, and dupliuts with Tax A:sessor.) ~
yo ~ 3 ~oaK i~ PACE 5~9
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