HomeMy WebLinkAbout0982 Declaratton ot Domicile and Citi~enship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA: 2231SS
This is my declaration of Domicile and Citizenship in the Sta?e of Flor~da that I am filing this day in ac~ordance and
~n conformity with Chapter 22?, Section 222.17, Florida Statutes.
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I was formerly a legal resident of - -
( ) ate)
and I resided at _ _ ~ Howeve~ 1 have changed my domiCile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ~ day of
_ 19~Q_, and I reside at ~:3~-~__2~~-if~C] ~`a ~`-^'v
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of titizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or businsss, or relinquishment of employment
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at former domicile, removal of family to new domicile, purchase of home, etc.)
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223158
f~~EO a,;o RECOaoEo
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CLERK ~ i:~~lT COURT
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~ I FURTHER CERTIFY that 1 will comply with r~ll other requirements of a legal resident -of this State.
~ 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. ~
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~ ~ . • • • , (Name) :
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Syyo~n'to~and subscribed before me this ~ day of 4_ . 19L-Z ;
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~ ROGER POITRAS _ ;
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i,~ K tIRCUIT COURT Notary Pubfic ~
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By D.C. My Commission expires
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(To b~ ~x~cuMd in dupliut~ and ori~inal filsd with Cl~rk Circuit Courf, and duplicat~ with Tax Ass~ssor.)
80GK~~9 PA~E ~C71.
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