HomeMy WebLinkAbout0757 ~
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DeClaration ot Domicile and Citizenship ;
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TO THE STATE AND COUNTY TAX ASSESSOR, • 't
Sl. LUCIE COUNTY, FLORI~A: ~
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in atcordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes. ~
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I was formerly a legal resident of ~~Q~~!?'±L~:2k~ ~
(City) (State)
and 1 resided at 1.~ ~~t~~ . However I have changed my domiCile
(Street and Number) ~
to and am and have been a bona fide resident of the State of Florida since . day of
- 19~~, and I reside at i/?" ~l g~ - - -
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FIORIDA
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 busi~ess, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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f~fD AND AE~yp
;T.~UCtE COWITY~
OCfR POtTRA~
CI.ERK Ct~CWT-~~~
RECORO VERlFtEO
MMt 1 10 si aN'T2
225114
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~ I FURTHER CERTIFY that 1 will oomply with all other rsquirement= of a leyal resident of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domiGile, and I intend to remain in FORT
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~ PIERCE, $,~?{NT•UJCIE COUNTY, FLORIDA, permanently.
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Sworn to and subscribed before me this ~L~ day of C~~i% /lv~~ , 19 ~Z
' ROGER POITRAS ~
ys CLERK CIRCUIT COURT Notary Public
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By ~.C. My Commission expires
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(To b~ ~xewMd in dupliut~ and oripinal filed with GKk Ci?wit Courf, and duplicats with Tax Ass~ssor.)
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