HomeMy WebLinkAbout1978 Declaration ot DomiCile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~2 ~
l~r/fr~78'73
Sl. lUC1E COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Flo~ida that I am filing this day in accordance and
~n confermity with Chapter 222, Section 222.17, Florida Statutes. ~
I was formerly a legal resident of - - _ _ - - '
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and I ~esided at However I have changed my domicrle ;
(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 `
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, ar~d I reside at _ ~ '
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- "!it/- 14 ~
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(Street and Numbr~y !
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FORT PIERGE, SAfNT LUCIE COUNTY, HORIDA ~ _
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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 family to new dumicile, purchase of home, etc.)
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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 retum to my former domiGle, and I intered to remai~ in FORT
~ PIERCE, SAINT LUGE COUNTY, FLORIDA, permanently.
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~ p~,~ ~-s~s-r.~ic.. ~ V'~ i~??~1w• ~
~ - . " (Name) ~
~ - :is; Ludmi la F. Raczynaki #
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< Swbm•to and subscribed before me this / day of t ~ , 19~~~
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ROGER POITRAS
CLERK CIRCUIT COURT Notary Public
- By 1~~ - D.C. My Commissian expires
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~ (To be ~xecuted in dupliute and original filed with Cl~rk Grcuit Court, and dupliut~ with Tax Assessor.)
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