HomeMy WebLinkAbout1465 Deciaratian ot Domicile a~d Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR. 223495 ~
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Sl. IUCIE COUNTY, FLORIDA~ i
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This ~s my declaration of ~om~cile and Citizenship in the State of Florida that I am filing this day in accordance and
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~n conformity with Chapter ?22, Section 222.17, Flo~ida Statutes. ~
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I was formerly a leqal resident of BR~~~'~ _ 70~ '
(City) (State)
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and I res~ded at _ 444 J8a8iC8 woe. However I have changed my domicjle ~
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(Street and Number) ;
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to and am and have been a bona fide resident of the State of Florida since ~~t _ _ day of ~
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Al~Bu_st ,~9__71_, and I reside at g~_'S Aisteritt Ave. ~
(Street and Number) F
FORT PIERCE, SAINT LUCIE COUNTY, KORIDA ~
and this statement is to be taken as my declaration ef citizenship, actual legal residence and domicile i~ ihe State of Florida. !
(Insert here any pertinent facts, such as sale ot property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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RES IDE~ICE
F~LED ey ; PECQRDEG
ST LUC ~ ,CUNTr F~A
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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 domicjle, and I intend to remain in FORT '
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~ PIERCE, SAINT LUCIE COUNTY, FLORIOA, permanently. .
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~ , R08E A~itBRICO '
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(Name) s
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. ' . _ 803 Risteria _$~e.~ l~t. Pierce,l~l. ~
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Sworn to and subscribed before me this ~__~h day of - @br119t~ , ~q~ _ '
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ROGER POtTRAS - -
- CUIT COURT . Notary Pubtic
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~ By D.C. My Commission expires
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(To b~ ~xscvNd i~ dupliuh and oripinal fil~d with Chalc Grcuit Court, and duplicat~ with Tax Ass~ssor.)
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