HomeMy WebLinkAbout2940 Declaration ot Domicile a~d Citizenship
•TO THE STATE ANO COUNTY TAX ASSESSOR, 2~~4533 ~
Sl. LUCIE COUNTY, FIORIDA:
This is my declaration of Domiule and Citizenship in the State of Florida that I am filing this day in accordance and
in confo~mity with Chapter 222, Section 222.17, Florida Statutes.
Ce~/Q 12 ~~d
I was formerly a lega! resident of _ _ _~l~~1 l1~.L~a _
(City) (State)
and 1 resided at ~C' K~ _ ~
~°~9 . _ _ _ _ However I have changed my domic,ile
(Street and Number)
;
fo and am and have been a bona fide resident of the State of Florida since _ day ot
~b r~?aR~ , t 9_.?_ L~D9 ~__d_ 7 h _~~s~ 7'L
~ 2, and I reside a~
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, fIORIDA
and this sfatement is to be taken as my declaratio~ of citizensh+p, 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 domicile, purchase of home, etc_)
j~ w e l ~r,c> e~ l~~+ ~4 ~rJe ~
f ~ED A1u0 RECORO D
WCIE COUNtY F~~{, ~
, ROQER POITRAS ~
CtERK CI~,CUIT Cpy~V +
; RECORD VER?FIEp
i t~e 1~ ~ ~ 24 .
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~ I 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 return to my former domi~ile, and I intend to remain in FORT ;
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanenNy. i
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v ~!-h~-~n1_~- _ (~~~p~e~
.y (Name) ~
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Sworn t~ sif~.~ubsuibed before me this _-2 day of -_~~~_r krr , 19~~,~ '
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= ROAf~.i~Q~~I?S, - - - - `
_ ~ ''~C~R~(~R COU T Notary Public
_ ,
By ~.C. My Commission expires _
(To bs executtd in dupliut~ and oriyinal filed with Cl~rlc G~cuit Court, and duplicate with Tsx Assessor.)
No 13 Q~i~ Fy r1 L i'r~/V~/ -