HomeMy WebLinkAbout0988 Declaration ot Domicile and Citizenship
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TO THE ~STATE AND COUNTY TAX ASSESSOR, ~
Sl. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Gitizenship in the State of Florida that I am filing this day in actorda~ce and
in conformity with Chapter 222, Section 222.17, Florida Statutes. ~
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I was forme~ly a legal resident of f~ _
(City) (State)
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and 1 resided ~t _ _ _ ~ _ _ . _ _ . However I have changed my domiCile
(Street and Number) ~
to and am have been a bona fide resident of the State of Florida since _l~__`-_____-_ day of
19~f , and I reside at ~ f .
Street a~d N%u~e
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FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA - " ' u~ ~
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 pertine~t facts, such as sale of property or business, or relinquishment of employment
at former domicile, ~emoval of family to new domicile, purchase of home, etc.)
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F
fILEO AN~ RECOaO
st.lUCfE COUM?Y f~•
ROCER POITRAS
CIERK CIRCUIT COUItT
RECORD YERIFIEO
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I FURTHER CERTIFY that I will comply with all other ~equirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former do 'cile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ . . - : Richard (Name) Werge
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' . Jeanette~)
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Sworn to and subscribed before me this day of , 19~Z
ROGER POITRAS
jC~RiC CIRCUIT OURT Notary Public
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B~r- D.C. My ~ommission expires
(To b~ ~xecut~d in duplicste and wi~inal fited whh CIKIc Grcuit Court, and dupliuh with Tax Assessor.)
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