HomeMy WebLinkAbout0130 Declaratlo~ ot pomicile and Citizenship
22465`~
TO THE STATE AND COUNTY TAX ASSESSOR, .
Sl. LUCIE COUNTY, FLORIDA:
This is my declaration of Dom~cile 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 _ _ _ _Gei21e~~1112__ _ _ ~T_$i_8
~C;ty~ (State)
and I res~ded at _ Rt 11 Lflke l?anch Drive '
_ _ However 1 have changed my domiG~e ~
(Street and Number)
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ro and am and have been a bona fide resident of the State of Florida since 1~ th _ day of +
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_ Jlll.y _ _ _ _ , 19_7.1 and I reside at _~~t__ 1_ _ 807C 13~ _ ~
(Street and Numbe~) ~
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FORT PIERCE, SAINT lUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or refinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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22465'7 ~
Establishin~ residence
fiLEO wN0 RE
ST.111C1E COUNTY LL
ROCER POITMt ~
CIERK CIRCUIT COf11tT
RECORD VERIfIEO~~
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` 1 FURTHER CERTIFY that I will comply with all other requirements of a leyal resident of this State.
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~ 1 FURTHER CERTIFY that I have no intention to refurn to my former domiG~e, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ _ • ; i ~ ~'~s~ ~G'...~~+~- u"- _ / -
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~ ~ - H~rbert ??ocheaton
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Swom to and subscribed before me this - 1'~ t day of ~~rCh _ _ ~ 9 _ 72
= ROGER POITRAS -
LE1tK CiRCU1T COURT Notary Public
a= 2 claL~ CV c.Y ~~-GG'L~
By - D.C. My Commiss~on expires _
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(To b~ ~x~cut~d in duplicsts and o~ipinal ~iled with GKIc Circuit Court, and duplipte with Tax A:s~ssor.) ~
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