HomeMy WebLinkAbout1232 Declaratio~ ot Domicile and Citize~ship
~ TO THE STATE, AND COUNTY TAX ASSESSOR, ' 2~431
Sl. lUC1E COUNTY, fIORIDA:
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This is my declaration of Domicile and Citizenship in the Stats of Florida that I am filinq this dsy in acoord~~te •nd `
in conformity with Chapter 222, Sectio~ 222.17, Florida Statutes. ~
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I was forme~ly a legal resident of 2~~~~ ~
(City) (Stat~)
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and 1 ~esided at ~.GN~ ~ . However 1 heve chanyad my docnic3le ~
(Street and Number) ;
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to and am and have b4en a bona fide resident of the State of Florida si~ce ruil~' /~7 day of ;
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~f~.~~~ , 19 and I reside at rf-s~ 3 _S~i.e"-cv~D-~- ~J ' ;
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FORT PIERCE, SAINT LUCIE COUNTY, PLORIDA
and this statement is to be taken as my detlaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any peninent facts, such as sale of property or busineu, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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f~~E~ ANO REC ~
. =T LUCIE COUN~ROEO
ROCER Pp~tRAS
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RE ORO yfc'~~Ult COU`
.?F1ED~~Gi~~C'~'
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` ~431 -
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~ I FURTHER CERTIFl( that I will oomply with all othe~ requiremenri of a leyal resider~t of this Stats. ?
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~ 1 FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in FORT
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s PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~~~P.r/ ~Name) ~~/Ji ~P ?
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~ '.Sworn~TC+and subscribed before me thi: ~ day of L~%~~~~~~'.!v 19 72
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ry~ ROGER POITRAS
r~' K CIRCUIT GOURT Notary Public
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~ 8y « ~.C. My Commission expires
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~ (To b~ ~x~cut~d in dupliwt~ snd o?i~inal fil~d witb C{~rlc Grcuit Court, and d~pticah with Tax Ass~s~or.)
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