HomeMy WebLinkAbout2511 Declaratio~ ot Domicile a~d Citizenship
~ ~ 22~24U
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, flOR1UA:
This is my declaration of Dom~cile and Citizenship in the State of Florida that I am fil~ng this day ~n accordance and
x
~n conformity with Chapter 222, S~ction 222.17, Florida Statutes. ~
1 was formerly a legal resident of t 1~[~~c~1 1- -
(City) (Sta ~
and I resided at ~ V ~QR~. _~~~11___-___ _ However I have changed my domiG~e
(Street and Number)
ro and am and have been a bona fide resident of the State of Flo~ida since ~ ~ 9~ - - day of
, 19_~ and ! reside at _ ~~I~~~!~
(Str and Numberl
FORT PIERCE, SAiNT lUC1E COUNTY, FLORIDA
and this statement is to be taken as my deciaration of cititenship, actual iegal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of properry or business, or relinquishment of employme~t
at former domicile, removal of family to new domicile, purchase of home, etc.)
.
I/lA QA i~.''C. ~a~
p~ ~ --1 ~ ~ ~ ~eJ ~ ~t. ~u-~c~
~c
• ~ ~N~ ~ IR.c-~x~r 1 i
,
~
~
2242~0 ;
' f~IEC ANO IIECpRpE~
' f . WCIE COWITY FLA.
' ROCER P~ITItAa
~ CLERK CtRCUIT COURT
i RfCOR~ YE~~i~E~.~,~....,~
~ i~ 1I IZ sz PM'11
i •
s
~ ~
~
~
~ S
~ I FURTHER CERTIFY that I will comply with al1 other ~equirements of a legal resident of this State.
F
~ ~
e
I FURTHER C~RTtFY that 1 have no intention to seturn to my former domic,ile, and I intend to remain in FORT
;
~ PIERCE, SAiNT LUCIE COUNTY, FLORIDA, permanently.
~ . . ~
. . _ --llh
' • • (Name)
x~ .
~ . ~
r~ • ;
i ' ;
.
~ • _t `S~ --~-~Y~- '
, (Address) ~
= ~
- ~ ;
" ~i % ~
,
~ Swom to and subscribed before me this day of ~~~.~1~~ 19~ L--
_ ~
ROGER POITRAS - - - - _
Gl~RK CIRCUIT COURT Notary P~blic :
, ~
~ B ~ : ` ` ~ < ` l D.C. My Commission expires - .T-- ~
- Y ~ - - - ~
(To bs ~xecut~d in duplicate and oripinal filsd with Cl~rk Circuit Court, sad dupliut~ with Tax Assessor.) '
gooK~yy Y~~F251U ~
" _ r~,~'. . _ _
. . .._9 v~'t. :'~.,.ri
, ~ " _.'a~