HomeMy WebLinkAbout0770 Decfaration ot Domlcile a~d Citizenship
TO THE STATE ANd'COUNTY TAX ASSESSOR, ~~W1~
Sl. IUCIE COUNTY, FLORIDA:
This is my declaration of Qomicile and Citizenship in the State of Fiorida that I am fil~ng this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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I was formerly a legal resident of ~?~{,G_~!~~~~~~. -
(City) (State)
and I resided at ~ 1~ LL/~+?-~(~~'~- 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 ~!~t"~ day of
t
~~~'~?'~L~~"''~ , 19? l. and I reside at IL'~ ~ S~ ~.~~'`~~F~-~`.-c GC-t"c' - +
(Street and Number) ~
~'cr-,-~ d,~ ~~.~_4 - ~--~c . ;
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 Qf Flo~ida.
(Insert here any pertinent tacts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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PIIED AMD ?'_Ci;R0E0
ST AUbE;.CO~ MRASU.
CIE~K t~'~=~" COURT
RF~GR'~ V"~ ~'ED_~~
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~ 1 FURTHER CERTIFY that I will comply with all other requirements of a legal cesident of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. /,2~-~-` '
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Swom to and subscribed before me this - day _ , 19
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- - ROGER POITRAS -
- K CIRCUIT URT Notary Pubtic .
~ 8y ~ D.C. My Commission expires
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- (To be executed in dyplicate and ari~inal filed with Cl~rk Grcuit Court, snd duplicat~ with Tax Assessor.) _
= 80~199 P~ 769
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