HomeMy WebLinkAbout0899 Deelaration of DoYnicile and Citizenship 223109
TU THE STATE AND COUNTY TAX ASSESSOR,
51. IUCIE COUNTY, FLORIDA:
This is rny declaration of Domicile and Citizenship in the State of Florida that 1 am f~ling this day in accordance and
~n confarmity with Chapte? 222, Section 222.17, Florida Statutes.
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1 was formerly a leyai resident of _ ~!1 hi SQt1_____ _ _ _ _ - - - ~-i-
(Ciry) (State) ~
and 1 resided at ~1 AC~~@ __!1~ However I have changed my domiCik
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since /`~k~ ~tS~ day of
_ _ _ _ 14~~ , and I reside at (~9L.~/~~~ z~~~ N C~~c~n _~t.~~e _Ir ~
(Street and Numbe~)
FORT PIERCE, SAINT LUCtE 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 fatts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
~v,,,,. S~'"~l 223109
iT~LUC E COUNTY F~A
ROC:~ POITR~S
CIERK CrFCUt? COUAT
RECpRO Y:~i~iEO ~
FE8 I ! 39 PM '1
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: 1 FURTHER GHtTIFY that I will comply with all other requiremenis of a 1e9a) resident of this State.
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~ 1 FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remai~ in FORT
~ PIERCE, SAINT.lUC1E COUNTY, FLORIDA, permanently.
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~ (Name)
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Swom to and subscribed before me this day of _~~~`?~-a~ , 19~?~
R ER POITRAS _
CIRCUIT COURT Notary Public
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By D.C. My Commission expires
(To b~ ~x~cut~! in duplicat~ and ori~inal fit~d with Ci~rk Circuit Court, snd duplicat~ with Tax Asse~sor.)
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