HomeMy WebLinkAbout1211 Declaration ot Domicile and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FlORiOA: ~~3~0~
This ~s my declaration of ~omicile and Citizenship in the State of Florida that I am filing this day in accordance and
conformity with Chapter 222. Section 222.17, Florida Statutes.
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1 was formerly a legal resident of _ 1'
~(City? State)
and I resided at 3~ U ~ , i~~~?~!~uCZ~-~.- - HOwever I have changed my dOmicjle
(Street and Number)
to and am and have been a bona fide resident of tfie State of Florida since Q~ .~P_~ _ day of
- - 1
ji~'~~~~
j~~ , 19 7~, and I reside at ~`'/_7.--~-- -
(Street and Numbe~)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida. '
(Insert here any pertinent facts, such as sale cf property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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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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~ I FURTHER CERTIFY that I have no intention to refurn to my former domicjle, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. /~~'A'E ~~'0 5 i li-
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~ (Name)
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- Swat~jto and subscribed before me this - ~ - day of _--'~~~~r
c« , 19~1/
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~JZ ROGER POITRAS _ '
:'1 CLERK CIRCUIT COURT Notary Public
_ ~ ~
_ By ~ D.C. My Commission expires
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(To be oxecuted in dupliuts and oripinal ~iled with tl~lc Grcuit Court, and dupliut~ with Tax Ass~ssor.)
r:s 1210
No. 13 A sooK 1y9 P1cE
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