HomeMy WebLinkAbout0740 Declaration ot Domicile a~d Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, ;~;~2994
Sl. IUCIE COUNTY, FIORIDA:
This is my declaration of Dc~m~cile and Citizensh~p in the State of Flo~ida that 1 am fil~ng this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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I was farmerly a legal resident of .<S~~IL - - - - - - s~~ =s-~
(C;ty) {State)
and I resided at _~lP K~- ~e~~'- However I have changed my domicrle
(Street and Number) i
to and am and have been a bona fide resident of the State of Florida since v~ ~ . day of
ll~t_? _ 19_ , and I reside at _ ~aQ -3 _ ~ ~ .
treet and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FtORIDA
and this statement is to be taker~ as my declaration of citizenship, actual lega) residence and domicile in the State of Florida.
(Inse~t here any pertinent facts, such as sale ot property or business, or relinqUishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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~~C~~ ST.IUCI~ ,,;;UNTY fLA. t
RO~s = ~:)tTR~g /
Gi'~'v1r a~ CIERK .JtT COURT y~~
.~C.~C.~'~ (1 ~ : ~r ~ . ~ ' E G ~J:...
i .~t+ 3f I i o~ AM '7Z
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° ~22594
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~ 1 FURTHER CERTIFY that 1 will comply with al) 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 domiule, and I intend to remain in FORT
~ PIEttCE, SAINT LUCIE COUNTY, FIORIDA, permanently. '
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. _ -~/~/Il~,~~-'-'--- _
~ (Name)
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(Ad ss)
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- Swom to and subscribed before me this day of , 19~L- '
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ROGER POITRAS _ i
CIERK CIRCUIT COURT Notary Public ~
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By - D.C. My Commission expires i
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(To be executed in duplicate and ori9insl filed with Clerlc Circuit Court, ar~d dupliut~ with Tax Aswssor.) t
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BooK 199 P~~E .739 ~
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