HomeMy WebLinkAbout1007 Declaration ot Domicile and Cit~zenship
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TO THE STATE AND COUNTY TAX ASSESSOR, 225265 t
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Sl. IUCIE COUNTY, FLORIDA.
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in actordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
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1 was formerly a legal resident of _ -
(City) (Stat
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and 1 resided at _ ~y . However I have chan ed m domitile
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(Street and Number)
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ro and am and have been a bona fide resident of the State of Florida since day of
- - - - - 19.1 and I reside at ~d _ 3
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(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in ihe State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at forme~ domicile, removal of family to new domicile, purchase of home, etc.)
225~65 _
fJ LEO AND RECORpEp ?
~T LUCIE COUNTY FlA.
CLERK
C~FCitl COU
RECORp VERIf1E0~,~~~r~
~ ,B 2 io PH ~71
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I FURTHER CERTIFY that I will comply with all other requirements of a lega) resident of thia State.
1 FtJRTHER CERTIFY that I have no intention to return to my former domiGle, and I intend to remain in FORT
PIERCE, S~~VrT LUClE COUNTY, FLORIDA, permanently_
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Svrrofn to and subscribed before me this fZ day of ~%'~~%li~=~'~~ , 19
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ROGER POITRAS
CLERK CIRCUIT COURT Notary Public
By D.C. My Commission expires
(To be ~x~cut~d in dupliut~ and ori~inal fil~d with G~ek Grcuit Cou~f, and dupliwt~ with Tax Ass~ssor.)
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