HomeMy WebLinkAbout2703 T
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Deciaration ot Domicli~ and Citizenship
TO THE STATE AND COUNiY TAX ASSESSOR, ~ ~~43'7v
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Sl. tUCIE COUNTY, FLORIDA: ~
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This is my declaration of Domicile and Citi=enship in the State of Florida that 1 am filing th~s day in accordance and
~n conformity with Chapter 222, Sectio~ 222.17, Floride Statutes.
I was formerly a legal resident of _ _ ~~L ~ _ _ - ~~L -
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(City) (State)
and I resided at .~9~ ~Q~%~'~'~_S 5_ _ Howeve~ 1 have changed my domi~ile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _ - day of
7~6/Cll[~~ 19~z, and 1 reside ae _1~G~z-- ~G'~ ~
(Sireet and Number)
FORT PIERCE, SAINT LUCIE COUNTY, HORI~A
and this statement is to be taken as my declaration of citizenship, act~al legal residence and domicile in the State of Florida.
(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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Eatablis!~ing reaidence
fILEO AMD REGOROE~
~T. L1iC1E C01i~TY flA. ~
R06ER POtT~At
~tf1il~ CI~CWT COYfIT ~
11ECOR~ rEaiF~E4
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~ 2~43'70 ~
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~ I FURTFi~R CERTIFY that I will comply with all other roquirementa of a le~al resident of this State.
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0 I FURTHER CERTIFY that I have no intention to return to my former domicile, and 1 intend to remain in FORT
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~ PIERCE, SAIN?. LUCIE COUNTY, FLORIDA, permanenNy.
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~ ~t,. ::.::~J G~ ~.~0-
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- - ~ I.ester " St. Peter
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• : .y~• . jk ; (Address)
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- ~to and suburibed before me this ~ day of , 19~.
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ROGER P0ITRAS _
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F.< <lRCUiT COURt Notary Public
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' By ~-~''~-L ~`'~~~'`'"V D.C. My Commissio~ expires
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(To b~ ~x~culyd in duplicsh and e~ fiMd wilA CMrk Cita~if CouA, and duplicah with Tax Aas~stor.)
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