HomeMy WebLinkAbout0762 ~ Deciaration of Don~icile and Citizenship
TO TNE STATE AND COUNTY TAX ASSESSOR, ~~M~ y
VV
Sl. tUCIE COUNTY, FLORIOA: f
This ~s my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
:n conformity with Chapter ?22, Section 222.17, Florida Statutes.
I was formerly a legal resident of a~/~r -!-_~7~ ~/Q/~ --aIC~-~
(Ciy) tate)
and I resided at #
~ _ V/7.~ N! _ Howeve~ I have changed my damiCi~e
(Street and Number)
to and am and have been a bona fide resident of the State of Florida s+nce ~ _ day of
~C..~ ,~j fQ.. , 19.7/ , and I reside at ~7~_ f ~ ~ y--`-~ ~ l.~ .
~ (Sireet a~d 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 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 to new domicile, purchase of home, etc.)
' ~~-~,c~ .
~
FILEG AN~J :°.fCOR0E0
ST IUC~E COUNTY fU. f
' ROG~~ P~11'RAS ~
! CLERK G' ~GUIT COURT
~ RE!'GR~~ y,~ tt=0
~ ,I~ 3t 12 zi PN'~t
t
~
i
C
i
~ 2~~~ ;
~
~
~
~
~ 1 FURTHER CERTIFY that I will comply with all other requiremenis of a legal resident of ihis State.
~
~ I FURTHER CERTIFY ihat I have no intention to return to my former domi~ile, and I intend to remain in FORT
§ PlERCEy.S+9?IAITs~,~iGE COUNTY, FLORIDA, permanently. ;
~ ` _ ~'S F"~' ~ t t. .i y
y~~~' ~ ~ r r •
1 i.
~f :a~ ' , 3~
~ ~ I _ . . ~ ' ~S (Name) -
'=V ' .
~ ' ' 7 - • i
- ;3 " ' / ,~L 3 L,/ .~.L.~ .
~ ~ : - (Address) '
- . . .
~a . . •
~ 4._.~.~-«, ,~7 2
- Swom to and subscribed before me this ~j - da , ly/ -
- ,
_
ROGER POITRAS
K CIRCUIT COURT Notary Publ~c
+
- By O.C. My Commission expires ~
,
F,.. /
~
(To bs executed in dupliute and original filed with Cl~rk Circuit Cou~t, and duplicats with Tsx Assessor.)
~ ~ ~
~ '10 13
.
~ _ _ - -
~ ~ - ~ - _ _ . ,u~_.