HomeMy WebLinkAbout0581 Declaration ot Domiciie and Citizenship
TO TNE STATE AND COUNTY TAX ASSESSOR. ~
:ii LUCiE COUNTY, FLORIDA ~~~~~0
Th~s ~s my declarat;or~ of Dom;c~!e~and Cihzenship in the State of Flor~da that i am fil~ng this day ~n accordance and
n conform~ty w~th Chapter 222, Sect~en 222 17, Florida Statutes.
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I ,Nas formeriy a !egal res~der.t of ~ _ _ _ ~
(C;ty1 (State)
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~~d R resided at `~f However I have changed my domi~ile
~ (Street and Number)
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•o and am and have been a bona fide resident ot the S1ate of Fforida 5"ince ` P~ day of
, 197~ . and I reside at /(G ~ l _ _ _ ~
(Slreet and Number) i
FORT PIERCE, SAINT lUC1E COUNTY, FLORIDA
~~d th,s statement ~s ta be taken as n,y declaration of utizensh`p, actual legal res~dence and dom~ciie ~n the State o~ Florida.
(Insert here any pert~nent facts, such as sale of property or busi~ess, or relinquishment of employment :
at former domicile, rernoval of family to new domicile, purchase of home, etc.)
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2~2940
fIIED ay? PECOR~~e
ST. LUCi~' COUMt~ A-
R~~E~. F~tTiAS
C~ER? C~~ CUtT COURT
AFCOF:"~i.= FIzG~~-
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~ J~+ T6 2- ~2 PH'7Z
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~ 1 FURTHER CERTIFY that I will compty with all other requirements of a legal resident of this State.
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~ I FURTHER CERTIFY fhat I have no intention to retum to my former domi~ile, and I intend to remain +n FORT ~
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~IERCE, SAINT LVCIE COUNTY, FLORIDA, permanentiy.
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r~~ ~ . • _ . ~ - Q-1_~.~_f~ '
~ (Name)
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b Swom to and subscribed before me this day a~'u~'~ 19Z~'~.
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;~Y ROGER POITRAS f
_ K CIRCUIT COURT Notary Public .
- B ~~~--F'~-Llc~ - D.C. M Commission ex ires ~
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e'~ (To be exewted in dupiicste and o~iginal filed with tlerk Circuit Court, and duplicate with Tsx AssessorJ ~
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go~K 199 FACE 580 '
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