HomeMy WebLinkAbout1717 Declaration of Domicile and Citlzenship
TO THE STATE AN~ COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FIORIDA: 223~~1
This is my declaration of,Domicile and Citiienship ir~ the State of Florida that I am filing ihis day in accordance and
~n conformiry with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of _ 1~~-~52!S1 --~f_1l1
q y~ _
~C;ty~ (State)
and 1 resided at ~3_ ~'~-Lo ~r-__--- _ . However 1 have changed my domitile
(Sireet and Number)
to and am and have been a bona fide resident of the State of Florida since !_~f~~._ l------- - day of
7 ' 33~ S~ ~ I a
_ 19L~__., and I reside at a'
- - - - - - - - - - .
(Street a~d Number)
~ORT PIERCE, SAINT LUCIE COUNTY, FIORIDA - ~ F ~ ~t •
and this statement is to be taken as my declaration of citizenship, adual legal residence and domicile in the State of Flo~ida.
(Insert here any pertinent fads, 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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G'l'1~GG~ ~ ,~~..fiJT A~`'
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COdMTY ~
110~4 t0?TRAS
CLERII C~~:CUtT COiNlT G~
RECORD YEP.IF~E~~
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~ I FURTNER CERTIFY that I will comply with al) other raquirementt of a legal resident of this State.
~ t 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, FLORIDA, permanently.
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(Name) ~qsrE rz,
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`s' ~ Sworr>.i+6. ~'subscribed before me this day of , 19~
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ROGER POITRAS
CLERK CIRCUIT COURT Notary Public
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gy + D.C. My ~ommission expires
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(To be oxecut~d in dupliuh snd oripinal fil~d with Cl~rk Grcuif Court, and dupliuN with Tax Ass~ssor.)
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~ s°cRr.1~9 F,~f~~ 171~
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