HomeMy WebLinkAbout1207 ~eciaration ~t ~omicile and CitiYenshlp
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TO THE STATE AND COUNTY TAX ASSESSOR, ~
51. LUCIE COUNTY, FLORI~A:
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This is my declaration of ~omicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Ftorida Statutes.
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I was formerly a legal resident of ~ ~ C..e . Q . _ . ~ :
(City) (State) ~
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and I resided at However 1 have changed my domi~ik ~
(Street and Number) ~
`o and am and have been a bona fide resident of the State of Flarida si~te ~~t. day of ~
F
, 19? ~ and I reside at p~/~~~ ~ ~~~2~'=
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(S t and Number) ;
FORT PIERCE, SAlNT I.UCiE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal ~esidence and domic+le in the State of Florida.
(Insert here a~y 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.) !
fIlEO J?y^ RECORoEO ;
8T.lUC~E COUNTY FtA, f
RaCER FOsTRAS ~ ~
CLERIC C:: ~t!!T COlJRT ~y( ~
RfCCR" vE~ ~FiED.~..
fEe ~ li 3~ AN'71
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u 1 FURTHER CERTIFY that I will comply with al) other ~equirements of a legal resident of this State. ~
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~ I FURTHER CERTIFY that I have no intention to return to my former domicjle, and 1 intend to remain in FORT ~
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. i
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~ swror~.,tqMand~ subscribed before me this _ _ _ _ day of ~..1~ _ , 19.~~ ;
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ROGER POITRAS - - - - -
_ ~ CLERK CIRCUIT COURT Notary Public ~
By - - _ D.C. My Commission expires ;
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= (To be ~xecut~d in duplicate snd oripinal filed w8b Cttrk Circuit Court, and duptiut~ with Tax Ass~ssor.~
6~oK 199 ~~..:1?06
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