HomeMy WebLinkAbout1190 DeClaratiOn of DomiCile and Citize~ship '~23,?9$
TO THE STATE AND COUNTY TAX ASSESSOR, ' ~ f
Sl. LUCIE COUNTY, FIORIDA~
This is my declaration of Domicile and Citize~sh~p in the State of Florida that 1 am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Ftorida Statutes.
i was formerly a legal resident of _ _ _ ~~dKO------- -
(City) (State)
;
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and 1 resided at 7? J - c~~-- However 1 have changed my domi~ile ~
(Street and Number) . i
t
to and am and have been a bona fide resident of the State of Florida sinceC~~» . - day of ~
~ ~-D .
- _ _ . 19_~~- , and 1 ~eside at _ ~-3
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
,
and this statement is to be taken as my declaration of citizenship, actual legaf residence and domicile in the State of Florida. ~
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of famity to new domicile, purchase of home, etc.) •
FILEO Al10 RECOROEO
F e p~q e Co ~ ST. LUCIE COUNTY FtA. ~
~ ~ ~ ROCEn FOtTRAS I
O CLERK CsaCUIT COURT ~~cc
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~ 1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
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I FURTHER CERTIFY that I have no inte~tion to return to my former domi~ile, and I intend to remain in FORT
~ ~
~ PIERCE, SAINT LUCIE COUNTY, FLORIOA, permanently. ~
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~ . ~ ~ ----_~,,~_~,~~..C.r~ _ ~
~ . ~ f;~•r (Name) ~
„ _ /7ed(s~Cof ~1 ~
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Swor~~ td aes8.svbscribed before me this day of , 191~_
_ - 4
ROGER POITRAS -
` CLERK CIRCUIT COURT Notary Public °
f
gy c C+ CC ~ c_ D.C. My Commission expires ;
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(7o b~ ~xecut~al in dupliute and ori~insl filsd with Cl~rlc Grwit Court, and dupliut~ with Tax Assessor.) ~
SOOK 1~ P~GE
t~o ] 3 p
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