HomeMy WebLinkAbout0838 Decla~atio~ ot Domicile and Cltizensh~p
TO THE STATE AND COUN tY TAX ASSESSOR, . . 22~4
Sl. lUC1E COUNTY, FIORIDA:
Th~s ~s my ~eclaration of Oomiuie and Citizensh~p in the State of Florida that 1 am fifing this day in accordance and
~n conformity with Chapter 222, Section ?22.17, Florida Statutes_
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I was formerly a legal resident of _ -
(City (State)
and 1 resided at . ~1 _ I~. However 1 have changed my domiG~e
(Street and Number) "
to and am and have been a bona fide resident of the State of Florida since day of
_ _ . _ , 19 , and I reside at ~ ~ `
. ~ ~ (Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Flo~ida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment af employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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` fKE 0 ~ND RECOttp~~
~ :T LuC~E CafMTr f~A.
ROCEA POITqA$
CIERK CIRCYIT CONRT
RECORd YE~IFIE~~.~~
f~e ! 9 3~ AM' t~
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~ 1 FURTHER CERTiFY that I will comply with al) other requirements of a legal resident of this State. '
~ I FURTHER CERTIFY that 1 have no intention to r turn t m f rm r mi 'I n 1 int n t r m'n in RT
k e o y o e do u e, a d e d o e a i FO
:d
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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ti . - . ~C~i't-ti ~ me) ~
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• ~ (Address)
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f ~SMrq~n tolbnd subscribed before me this - day of _ , 19~.
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'f$ ROCER POITRAS _ i
~~RK CIRCUIT COURT Notary Public ~
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- gy ~'e ~~~='~L~ D.C. My Commission expires
(To bs ~xecuted in duplicat~ and oripinal filed with CIKIc Grcuit Courf, and duplicaN witt~ Tax Asa~saor.)
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