HomeMy WebLinkAbout1670 Declaration ot Domi~Cile and Citizenship
TO THE STATE ANO COUNTY TAX ASS:SSOR, ~~~A ~
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Sl. lUC1E COUNTY, FIORIDA:
This is my declaration of ~omicile and CitiZenship in the State of Florida that 1 am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Flo~ida Statutes.
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I was formerly a legal resident of ~ - - ~ -
(City) (State)
. ~
and 1 resided at ~j!~-~ _l
f~~~_ ~ . Howeve~ I have changed my domic.ile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ~F day of
/
, 19
~and I reside at J' D J ~ " ~ ~ `-"'~s-+~
- - - - - (Street and Number)
FORT PlERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is io be taken as my declaration of citizenship, adual 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 employme~t
at former domicile, removal of family to new domicile, purchase of home, etc.)
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~ 223644
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~ 1 FURTHER CERTIFY that I will oomply with all other requirements of a Iggal 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, SAIN7 LUCIE COUNTY, FLORIDA, permanently.
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,
~ (Name)
~ . ~
~ . -
' - ~ (Address)
;
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~ 5wwii`to ~nd subsuibed before me this day of . 19-~i
~t=a
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ROGER POITRAS
CIRCUIT COURT • ~ Notary Public
By ~ N D.C. My Commission expires
~YK ~ ~
(To b~ exscutsd in duplicsM and ori~inal fi{ed w~th qerk Circuif Court, and duplics}~ with Tax Ass~sfor.)
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