HomeMy WebLinkAbout0839 ~eclaration ot Domiciie a~d Citisenship
TO THE STATE ANU COUNTY TAX ASSESSOR, 22~O6S
51. LUCIE COUNTY, FLORI~A:
This is my declaration of Oomicile a~d Citizenship in the State of Florida that ~ am fiting 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 _ /
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and 1 resided at _ _ _ .7 ~ _ _ . - _ Nowever ! have changed my domiCile
(Street and Number)
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to and am and have been a bona fide ~esident of the State of Florida since 3 _ day of
_ , _ ~L~ " - - - 19
~l and I reside at _~n.i ~Z~_ S ~'1~'Ja - -
; ~ ~ (Street and 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.
(Inse~t 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.)
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CIFRKCCjRCU1T COURT
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- I FURTHER CERTIFY that 1 will comply with all othe~ requirerr~ants of a lega) resident of this State.
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~ I FURTHER CERTIFY that 1 have no intention to return to my former domiGie, and I intend to remain in FORT
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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= - _ (Address)
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, Swom fo and subscribed before me this _ ~ day of -°i~~"G~_'`_""~' ~ , 19~Z'
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ROG R POITRAS _ _ _
C CtRCUIT CO RT - Notary Public
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y 8y D.C. My Commission expires _
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~i (To b~ ~x~cut~d in duplicat~ and original fiilsd with CIKIc Grcuit Court, snd duplicst~ with Tax Assessor.) -
~ ~coK 199 r~cE 838
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