HomeMy WebLinkAbout1735 Declaratlon ot Domicile a~d Citisenship
~O THE STATE AND COUNTY TAX ASSESSOR. 223683
Sl. IUCIE COUNTY, FLORIDA:
This is my decla~ation of Domicile and 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.
I was (ormerly a legal resident of ~O ~+~~T SlN - -`L/S_C v.V
(City) (State)
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and 1 resided at ~ ~o~c_ ~~Q Howeve~ 1 havechanqed my domiv~e
(Street and Numbe~)
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to and am and have been a bona fide resident of the State of Florida since ~l. _ day of
~g . , 19 , and I reside at c,~ 9 i3 . _ ~!+_~~li-~oup _ ~N ~v~ _
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration 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 farnily to new domicile, purchase of home, etc.)
P?~ cH.~ sE o /~o.~..t r9 r a 9~3 s^'~iec~• o~.v ~.~..ic ~s /-~~~cM..v~.v~
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~ 1 FURTHER CERTIFY that I will comply with al) other requirements of a legal resident of this State.
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~ I FURTHER CERTIFY that I have no intention to retum to my former domiule, and I intend to remain in FORT
~
~ PIERCE, SAINT lUC1E COUNTY, FLORIDA, permanently.
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r,~ Sworn to and subscribed before me this _-L~- day of . 19~-
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ROGER POITRAS _ - -
- K CIRCU COURT Notary Public
By D.C. My Commission expires
(To be executed in duplicate and originsl filed with Clerk Circuit Courf, and dupliuts with Tax Assessor.)
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