HomeMy WebLinkAbout1272 Declaration ot Dor~icile and Citise~shjp
TO THE STATE AND COUNTY TAX ASSESSOR. ~2335~ ~
Sl. IUCIE COUNTY, FLORID~ ~
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This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
~n conformity with Chapter 222, Section 2~2.17. Florida Statutes.
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I was formerly a legal resident of , _ _ _ - - - - -
~C;ty~ (State>
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and 1 resided at ~_-S y _ However I have changed my domiCile ~
(Street and Number) i
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ro and am and have been a bona fide resident of the State of Florida since . _ _ _ day of ~
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, 19_~~., and I reside at - - - ~
/ ( reet and Number)
fORT PIERCE, SAIIS~ LUCIE COUNTY, fLORIDA
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and ihis stateme~t is to be taken as my declaration of citizenship, actuat 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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~ 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 return to my former domic,ile, and I intend to remain in FORT
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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• `.?`•%r;, (Name)
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~Swqtn t~~n21,'iubscribed before me this day of , 19~,~-
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ROGER POITRAS -
K CIRCUIT CO T Notary Public
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By D.C. My Commission expires :
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(To be exscuted in duplicats snd original filed with G~rk Circuit Court, and dupliute with Tax Assessor.) ~
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