HomeMy WebLinkAbout1341 Deciaration ot Domicile and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~t~Q~ ~
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51. LUCIE COUNTY, FLORIDA: ~
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This is my declaration of Domicile and Citizenship in the Sta~e of Florida that 1 am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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I was formerly a ~egal resident of ;,J ~G n
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(Ciry) (11ate)
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and 1 resided at .~'~1_.---- - However I have changed my domiCile ~
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(Street and Number) . ~
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ro and am and have been a bona fide resident of the State of Florida since ~~c.. _ - day of ~
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__~~~e. i~ i-[Y_'L , 19~! , and I reside at l _~L:~f~ ~ ' ~ -1 -f - - ~
(Street and Numbe~) ~
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FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citiienship, actual legal residence and domicile in the State of Florida. 3
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(Insert here any pertinent facts, such as sale of property or busi~ess, or relinquishment of employment
at former domicile, removal of family to new domitile, 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 1 have no intention to retum to my former ciomic,ile, and I intend to remain in FORT 4
~ PIERCE, SAINT UJCIE COUNTY, FLORIDA, permanently. ~
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- SwOrn fo and subscribed before me this - day of , 19~'Z- ~
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~ ROGER POITRAS - `
K CIRCUIT COURT Notary Public t
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By a'`~'e D.C. My Commission expires
(To be sxecut~d in duplicats and oripinal ~iled with G~irlc Grcuit Court, and dupliuts with Tax Assessor.)
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