HomeMy WebLinkAbout1280 D~claration ot Domtcile ~nd Citizenshlp
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TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE CQUNTY, FlOR1~A:
This is my declaration of Domiciie and Citizenship in the State of florida that 1 am fiiing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes_
I was formerly a legal resident of ~G--'-
(Ci ) ?(State)
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and I resided at ~~5~ `~__<<`~~ ""~"~'_~~~~r'+v However 1 have changed my domicjle
(Street and Number) £
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to and am and have been a bona fide resident of the State of Florida since Lf.Lf ~ - _ day of
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_ . _ _ . , 19__ 1 ~ and I reside at _ ! - - - - - ;
tr nd Number) ?
`~T.GI ~ `~~f • '
FORT PIERCE, SAIN? LUCIE COUNTY, fLORIDA }
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and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Flo~ida. ;
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to ~ew doReicile, purchase ot home, etc.)
['~.Z-~IC-~l~c~~• ~CQ~ , ~i~GQ~cIG C~
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FILEO l~Ne RECORDEO
fT.IUCIE COUMTII fLA.
ROCE~ FO~TRAS ~
CLERK C' .CUI' COURT
i RE~OP.," Yf~~~~iE~~l~
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~ 1 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 domi~ile, and 1 intend to remain in FORT '
~ PIERCE, SAINT WCI~ COUNTY, FLORIDA, permanently. '
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Sworn to and subscribed before me this _ day of , 19~2~ i
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ROGER POITRAS ~ - _ '
= CLERK CiRCUIT COURT Notary Public i
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_ By D.C. My Commission expires `
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(To b~ oxecuted in dupiicat~ and original fitsd witk Cltrlc Circuit Cour~, and duplicats with Tax Assessor.)
S~
it No. 13
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