HomeMy WebLinkAbout2371 ~ Declar~tion ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~'~145
51. LUCIE COUNTY, FlORIOA:
This is my declarateon of Domicile and Citizenship in the State of Florida that I am tiling this day in acto~dance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of . _ _ ~ _ _ _~0 _ _ - - - - _
(Ciy) (State)
and I resided at However 1 have changed my domi~il~'"
(Street and Number)
fo and am and have been a bo~a fide resident of the State of Florida since ~..~v~ - t~ _ day of
- - - - 19~, and I reside at lQ r~~~~ -
(Street and Number)
FORT PIERCE, SAINT lUC1E COUNTY, FIORIDA
and this statement is to be taken as my declaration of citizenship, actual legal resicience 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 domicile, purchaie of horree, etc.)
.
~ ' vC, _
~
ST~WC E COUNTYRfI~,
ROCER FOITRAS
CLERK CIRCUIT COUltT
RECORO VERlFIEO..,.~,~`
~ Z~ 44 ' 1~'~,
AM tt ~
` ~%~145
~
~
3E
C
9
~
~g
0
5
3
c
~ I FURTHER CERTIFY that I wil) oomply with all ather requirements of a legal resident of this State.
~
~ I FURTHER CERTIFY that 1 have no iniention to return to my former domicile, and 1 intend to remain i~ FORT
~
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~ • .
~ -
~ - . . - me)
wj
„q
~ .
C~4 ' ~ i
_ (Address) +
_
4;
.Swora to and subscribed before me this '2~ day of , 19~z--
~
~a
.
:r~ ROGER ~OITRAS _ _
'~LERK CiRCWT COURT Notary Public
E:; 4-C-~i.t~C~. ~C'Z. Lt~/
~s ByJi D.C. My Commission expires
a
Ro b~ ~x~cvt~d in duplicsh snd orispnil f+bd wiH~ Clerlc Grwit Courf, and dupliut~ wilh Tax Ass~sso?.)
~~~K199 ~~~E2370
`
s r~o , ~ ~
- ~
_ _
~ ~ r_ . _ . _ . . _ ~ . ,