HomeMy WebLinkAbout1426 Declaration ot Domicile and Cltisenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~
Sl. IUCIE COUNTY, FIORIDA: ~
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This is my declaration of Domicile anti Citizenship in the State of Florida that I 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 legal resident of 1 ~l_ - - - ~ ~ ~ - - ~ - - " #
~C~N~ (State) ~
and I resided at ~~S ~ . However 1 have changed my domiCile
(Street and Number)
to and am and have been a borsa fide resident of the State of Florida since~~ '2 e--- - - day of
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- - _ , 19~1_. , and 1 reside at ~~O lG~t-~- .~ti _~~t_~._~~ ~ - _ ~
(Street and Number) ~
fORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my decla~ation 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 relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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FILEO ANO RECOROEO !
ST.LUC'•' C~UNTY F~~, j
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CLERl, r r yiT C~URT
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~ 22.3468 '
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1 FURTHER CERT{FY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiule, and I intend to ~emain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. "
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, (Name)
. ~e~r~~I ~3~~•cke_
~ C' ( <cx ~a..,i~, ~~c~:~ G--~-c~
~ ' - (Address)
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• . . = ~ ~ •t~ ' '_'~~~C~ .
= S~+i~orrl to and subscribed before me this - day of 19~-
~
ROGER POITRAS - ~
CLERK C{RCUlT COURT Notary Public '
\
gY ~ .~'1'?C ~CL_ D.C_ My Commission expires
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(To be axecuted in duplicate and originsl ~iled with Clerk Grcuit Court, and dupliut~ with Tsx Asses~r.) ~
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- ioac199 ~i~25
No 13 A
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