HomeMy WebLinkAbout1220 De~laration ot Domicile a~~d Citlsenship
TO THE STATE AND COUNTY TAX ASSESSOR. ~2331'7 ~
Sl. LUCIE COUNTY, FlOR1~A: ~
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This is my declaration of ~omicile and Citizenship i~ the State of Florida that I am filing this day in accordance and
conformity with Chapter ?22, Section 222.17, Ftorida Statutes.
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I was formerly a legal resident of _ r . _ _ _ _ _ _ _ _ Vv. _
(Ciry) (State)
and 1 resided at . ~ / ~ _ _ _ _ However I have changed my domicile ~
~ (Street and Number)
ro and am and have been a bona fide ~esident of the State of Flo~ida since ~ - - - day of
~~Q/Ql , 19__~~, and I reside at _ ~~~d ~ -
(St~eet and Number)
FORT PlERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual lega) residence and domicile i~ the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment s
at former domicile, removai of family to new domicile, purchase of home, etc.)
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E ~~~NTY f~~[.
ROC= R POITRAS ~
CLERK i':;GU~T COUA1
RECOP.C YE-1-tE0.~,~~~
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~ I FURTHER CERTIfY that I will comply with all other requirements of a legal resislent of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
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PIERCE, SAlNT LUCIE COUNTY, FLORIDA, permanently.
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x ~ ~ (Name)
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. _ . (Address) ~
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Sworn to and subscribed before me this - day of , 19_ ~
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" ROGER POITRAS ;
k,:y ~K GIRCUIT COURT Notary Public ~
2G~tC~~ -L~~ ~
~ By ,D.C. My Commission expires ~
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(To be ~x~cut~d in dupliuts and ori~insl ~iled with Cl~rk Circuit Court, snd duplicate with Tax Asses~r.) ~
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