HomeMy WebLinkAbout2974 Declaration ot Domicile and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR, '
Sl. lUC1E COUNTY, FIORIDA~ I~rl~r4S~~
This is my decla~ation of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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I was formerly a legal resident of . _
- - v - -
(City) - - - - i,, (State) ~ -
and I resided at y ~~~-~!`-s~C However I have changed my domiGle
(Street and Number) '
- v1'
to and am and have been a bona fide resident of the State of Florida since - day of
- - - 19~ l, and I reside at ~3_~ ~<-~.c. ~-~c ~~C. _~'~~~i l : ~ L .
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in ihe 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.) ~
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~ ~~~~~-r~
' .f ~fp ~?MO RECO1t~
f~, ~qCtE COUMTY FLA.
j ROGER FO~fRAs a .
~ CLERK C~~CUft COU~
~ RECORO ~~t'~~f 0~- _
j ~ 18 2 0~ PM'~Z i
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~ I FURTHER CERTIFY that 1 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 domiGle, and I intend to remain in FORT :
. ;
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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1~~I INf H )1!I . ~
;~`~~Gvl l:r C'~rjif~ (Name) :
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, ' , s~ , o~ `7 °Z / K-o~-[~x~ ' -
- " i . ~ ~ ~ (Address)
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_ day of -'au~r , 19 7•-?,
'~.'•SwtXa to ar~d`subscribed before me this - ~ ~ -
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ROGER POITRAS _ _
- CLFRK CIRCUIT COURT Notary Public
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By ~k~- '`x<«•• D.C. My Commission expires
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- (To b~ ~xecutad in dupliute and oriyinal filed witl~ Cl~rlc Grcuit Court, and duplicat~ with Tax Assesso?.)
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