HomeMy WebLinkAbout0991 Declaratlo~ ot DomiClle and Citizenshjp
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TO THE STATE AND COUNTY TAX ASSESSOR, +
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Sl. lUC1E COUNTY, FLORIDA: ;
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This is my declaration of Oomicile and Citizenship i~ the State of Florida that I am filing this day in accordance and ~
in conformity with Chapter 222, Section 222.17, Florida Statutes. ~
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I was formerly a legal resident of _ _ _ ~1__-_^ _
(City) (State)
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and I resided at `~s -r'~'~~~~'~Q' 'E'` However 1 have thanged my domiCile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since day of
- - - - . 191 and I reside at ~ °7 ~ ~aC.. / G ~ - -
(Street and Number)
FORT PIERCE, SAINT LUt1E COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, adual legal residence and domicile in ihe State of Florida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.) ~
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i1tE8 AND RECOROE~ '
~Q~~~ =T lUC1E COUNTY fl
ROCER POITRAS
CLERII Ct~CU1T COURT
RECORQ YERIFIED..r,.,~~
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1 FURTHER CERTIFY that I will comply with all other requirements of a le~al resident of this State. ~
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I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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Sworn'.to' and subscribed before me this day of G~'!~- , 19 ~ Z-
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ROGER POITRAS
CIRCUIT COURT Notary Public
By ~ D.C. My Commission expires
(Ta bs ~x~cvhd in duplicat~ aed oriqinal Fl~d with Ci~rlt Grcuit Court, and dupliut~ with Tax A:s~sso?.)
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