HomeMy WebLinkAbout1210 Decla~ation of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~
Sl. lUC1E COUNTY, F~oR~oA: ~23307
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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I was formerly a legal resideM of _ - - - - -
(Ciry) (S a ) ~
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~ Nowever I have chan ed m domi~ile ~
and I resided at _ 3 - L ~ 9 Y
(Street and Number) '
so and am and have been a bona fide resident of the State of Florida si~ce b day of
~ti:S.~ l.~~ , 19
x~, and 1 reside at P~. ~ x 1GT~~~-- - -
- ~ ~
~ (Street and Numbe )
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FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actval legal 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 family to new domicile, purchase of home, etc.)
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it lUC1E ;,Oi1NTY F~A.
ROCC^ POttRAS
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~ I FURTHER CERTIFY that I will comply with alt other requirements of a legel 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 remain in FORT
~ PIERCE, SAINT WCIE COUNTY, FLORIOA, permanently. ~~s ~e /y~ ~t Si d
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~ ~ • ~ (Name)
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- Sworn fo and subscribed before me this day of , 19 ~
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3 ROC ER POITRAS
CLERK CIRCUIT COURT Notary Public
` By D.C. My Commission expires
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(To bs sxecuted in dvplicate and ori~inal ~iled with Cltrk Grcuit Court, and dupliuts with Tax Assessor.)
BGRK 1y3 ~;~E 1209
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