HomeMy WebLinkAbout0594 Declaration ot Domlcile and Citizenship
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TO THE~ STATE AND COUNTY TAX ASSESSOR, QQ~ j
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51. LUCIE COUNTY, FLORIDA: 4
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This is my declaration of Domicile and Citizenship in the Sta~e of Florida that 1 am filing this day in accordance and ;
~n conformiry with Chapter 222, Settion 222.17, Florida Statutes. ~
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1 was formerly a legal resident of ~~~EC~~,~~~_ ~o~__Qo ;
(C;ty) ~ (State) ~
. _ _ _ _ . However I have changed my -'omiCi~e +
and I resided at ~~E~ff~lrl_ sI_u~cTie~c/ ~
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since day of
19~_, and 1 reside at ~7~"~O J' ~-f~ /Y U~ / ~ ~_v~ .
(Street and Numbe~)
FORT PIERCE, SAINT LUCIE GOUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Inser~ here any pertinent facts, such as sale of property or business, or relinquishment of emptoyment
at former domicile, removal of family to new domicile, purchase of home, etc.)
~S~~O~~is.C. .~~5 i c1r~c~ ~
. F~~eo ~MO RECOao~p ~
St. LUCIE COUNTY fLA. ~
ROCER POITRAS ~ #
ClERK CIRCUIT COURT
RECORD YE=:~FJEO i
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~ 1 FURTHER CERTIFY that I will comply with all other requirements of a(eyal resident of this State. ~
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~ I FURTHER CERTIFY that I have no intention to return to my former domicjle, and f intend to remain in FORT ~
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~ PIERCE, SAINT LUCIE COUNTY, FlORIOA, permanently.
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Sworn to~'nd subscribed before me th~s ~ day of , 19 7-Z-
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~ ROGER POITRAS
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CLERK CIRCUIT COURT Notary Public
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By - D.C. My Commission expires
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°3 Ro b~ ~x~cuf~d in duplicah and ori~inal fif~d with CINfc Girwit Court, and duplicat~ with Tax Ass~ssor.) ~
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Np 13A
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