HomeMy WebLinkAbout1217 DeClaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, IG 2331 ~ i
Sl. IUCIE COUNTY, FIORIDA: -
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This is my declaration of Domitile and Citizenship in the State of Florida that I am filing this day in accordance and ~
~n tonformity with Chapter 222, Section 222.17, Florida Statutes. ~
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I was Formerly a legal resident of ~ - ` - - _ . i
(C;ty) ~ (S te)
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and I resided at _ ~t,~~ _ Nowever 1 have changed my domiCile i
(St~eet and Number)
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to and am and have been a bona fide resident of the State of Florida since _ day of ~
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~,y4c,,~~2~J . . _ , 19 ?!and I reside atcC~~J' - -
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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 of property or business, or relinq~ishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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223~14
FIlEO AYQ RECOROEO ?
ST. LUCi~ COUNTY FLA.
ROCE? POITRRS
; CtERK C: ~CUlT COURT
i RECORD YE~~=!FD
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~ FE8 ~ I o3 PN '71~,~i
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~ 1 FURTHER CERTIFY that I will comply with all other requirements of a(egal resident of this State. ;
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~ I FURTHER CERTIFY that I have no intention to return to my former domiCGle, and I intend to remain in FORT ~
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ ~awOt~ tb a~d subscribed before me this ~ day of , 19~_. ;
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ROGER POITRAS
_ LERK CIRCUIT COURT Notary Public
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= dy v~~-~ O.C. My Commission expires
=a~~ (To be executad in duplicate and oripinal ~ifed with Cl~rlc GrcuN Court, and duplicat~ with Tax Assessor.)
BOCKl~ PaCE1z~,s
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