HomeMy WebLinkAbout0265 2M4~51
Deciaration ot Domicile and Citizenship
TJ THE STATE AND COUNTY TAX ASSESSOR, ' ;
Sl. LUCIE COUN7Y, FLORIOA~ ~
This is my detlaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
~n conformiry with Chapter 222, Section 222.17, Fiorida Statutes.
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I was formerly a legal resident of __-~"e~~' .
ity) tate)
and .1 resided a? _ ~L~E~ ~2J.~Q~ L/ ~ ~ _ _ _ _ . . However 1 have changed my domicj~e
(St~eet and Number) . ~
ro and am and have been a bona fide resident of the State of Flo~ida since _ _ day of
~X~L~~t~~'~1L__----_-_. 19~ , and 1 reside at ~
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(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, HORIOA
~~nd this statement is to be taken as my declaration of citizenship, actual legal residence and domiciie in the State of Florida.
(tnsert here any pertineni facts, such as sale of p~operty or business, or relinquishment of employment
at former domiciie, removal of family to new domicile, purchase of home, etc.j ?
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ROCER P~lTRAS ~ `
: CtERK C~~CNIT COU
RECORD VER1F1Ep~Y
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~ I FURTHER ~ERTIFY that I will comply with all other requirsments of a IeQal resident of ihia State.
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~ 1 FURTHER CERTIFY that 1 have no intention to return to my former domiCile, and 1 intend to remain in FORT
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ . ~ AATHONY ~l""e~ PIRKI, ~
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235 Summer Road, ~'t. Pierce, Fla. _
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_ _ cndd~~:) 33450 '
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- . +Sworn to and subscribed before me this ~ ^ ~ ~ day of / , 191.Z.r-
3 ROGER POITRI?S -
- CIRCUIT COURT Notary Public
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- By ~ D.C. My ~ommission expires ~
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Ro b~ ~x~evhd in dupliut~ and ori~ina! fil~d witb Cl~ic Getuif Couirt, snd duplieah with Tax Ass~ssor.)
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