HomeMy WebLinkAbout0341 Deelaratlon ot' Domicile and Citizenship ~
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORI~A: '
This is my declaration of Oomicile and Citizenshi~i in the State of Florida that I am filing this day in acmrdance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was forme~ly a legal resident of __~//E~~ __!f~Ry`~Nv _
(City) (State)
and 1 resided at ~a~._ ~EsTC `l~sTE~ ~R 3 O z-. However 1 have changed my domicu~e
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _ _ day of
-----~/~RC!~------, 19 , a~d 1 reside at ~~~8 ~ r /O T~ S'i.
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIOA
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 relinquishment of employment
i
at former domicile, removal of family to new domicile, purchase of home, etc.) ~
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f LED ~?MD R~~QR~E4
:~.~,UCIE CO Nlr u~ ~
j IIOCER POITQA: ~
~ CIERK CtACU~T COYR~
~ RECOAO VERKIEO
` MAt ~ S SO ~M'ZI
~ 224803
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~ I FURTHER CERTIFY that 1 will oomply witfi all other requirements of a leflal resident of thia State.
I FURTHER CERTIFY that I have no intention to return to my forme~ domicjle, and 1 i~tend to remain in FORT
~ PIERCE, SAINT LU~IE COUNTY, FLORIDA, permanently.
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Sworn to arid~ subsuibed before me this ~ day of •y~•~,~ , 19L°'L
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ROGER POtTRAS
t~ CLERK CIRCUIT COURT Notary Public
,
By ~e- ~ D.C. My Commission expires
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' Ro M~x~cut~d in dupliuh and oripinal Rl~d witb CIMic Gradt Cou~, and duplicat~ with Tax Ass~or.)
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