HomeMy WebLinkAbout1079 Declaration ot Domicile and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR, Z23219 ~ ~
Sl. IUCtE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
in conformiry with Chapter 222, Section 222.17, Florida Statutes.
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1 was formerly a legal resident of~fl _ -
(City) (State) ~
and I resided at _~_.~t,t.(~tJ Q~ ~O_Q~_ . However 1 have thanged my domitile
(Street and Number)
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ro and am and have been a bona fide resident of the State of Florida since . - day of ~
t
4 . ;
- - _ _ _ - - 19~ and I reside at ~~~~CJ.r~.~.~.~.<<
(Street and Number) }
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDI!
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in ihe State of Florida.
(Insert here any pertineni fads, 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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f?-~lUC1E ~~~nAFIA.
ROCE3 FOtTRAS ~ ~
CtfRK Ci=:CillT COURT t ~
RfCORO VE!'tFIEO~.,,~ ~
~e 3 10 3v AM'11
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~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State. ~
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~ 1 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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~ ~ ~ (Na e) ~:veiv'os d
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_ . (Address)
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Sworn to and suburibed before me this ~ day of , 19~Y ~
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ROGER POITRAS
CLFRK CIRCUIT COURT Notary Public
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By D.C. My Commission expires ~
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" Ro b~ ~x~cut~d in duplicat~ and original ~ilsd with CIKk Gnvh Court, and dupliut~ with Tax Ass~s~.1
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~ BU~K ~ar.r _
~ ° R 199 1078
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