HomeMy WebLinkAbout1173 Deciaratton ot Domicile and Citisenship
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TO THE STATE AND COUNTY TAX ASSESSOR, .
225392
Sl. LUCIE COUNTY, FLORIDA:
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This is my declaration of Domiciie and Cit~zenship in the State of Florida that I am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes. .
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I was formerly a legal resident of
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and I resided at ~
T_ However I have changed my domiCile ~
(Strc3et and Number) t
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to and am and have been a bona fide resident of the State of Florida since 3/'S day of
D~~C g~~ 19 and I reside at 'c A v~`sTA oL'~'~ ,
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(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, fLOR1~A
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 business, or relinquishment of employment :
at forme~ domicile, removal of family to new domicile, purchase of home, etc.) '
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I FURTHER GERTIFY that I will comply with all other requirements of a legal resident of this State. }
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~ I FURTHER CERTIFY that I have no intention to return to my former domicfle, and 1 intend to remain in FORT
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~ ~
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Swom to and subscribed before me this ~3 day of L~~'i~~~~~~ , 19~.
ROGER POITRAS
CIERK CIRCUIT COURT ' Notary Public ;
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? ay D.C. My Commission expires ~
~ Ro be ~xscuted in duplicate and oripinsl filed with CIKk Circuit Court, and duplicsts with Tax Assessor.) ~
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