HomeMy WebLinkAbout1248 Declaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, I~r~,s4 2~
51. IUCIE COUNTY, fIORIDA: t
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This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and t
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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1 was formerly a legal resident of --~~'~-r~ '
(Ciry) (State)
and I resided at .~_~L~_ _ _ _ _~.~2~1L _ _ ~ _ However I have changed my domiCile
Cy~l i~~ Street and Number
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to and am and have been a bona fide resident of the State of Florida since ~2-~_--L-~Z~----- day of
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- - - 19---, and 1 reside at •
(Street and Numbe~ . ~,/f ~
FORT PIERCE, SAtNT LUCIE COUNTY, FLORIOA
and this statemeni 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 former domicile, removal of family to new domicile, purchase of home, etc.) ±
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FllEO AND ~tECOR
sT ~l1~~E COUlIT1~
CIEAR~~ ~tCUIT~S
RECORD YEP,;FSE07~~~
' 13 3 44 PH 'T2
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~ I FURTHER CERTIFY that I will comply with al) other requirements of a legal resident of this State. ~
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~ I FURTHER CERTIFY that I have no intention to retum to my former domiule, and I intend to remain in fORT
~ PIERCE, ~AIN1 L~1CIE COUNTY, FIORIDA, permanently. 's
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. . . . , G: ~ = ARv ~ ~Name) ~~~•e7~ ~
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$worn to and subscribed before me this day of ~%'~'~l u~ , 19 ~-2
ROQER POITRAS
`;s ~ C~RK CIRCUIT CO~RT ~ Notary Public
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gy ~ u«<w ' 1Jt~~0.C. My Commission expires ~
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(To be ~xecuted in duplicat~ and ori~inal ~il~ci wi~h Cl~rk Grcuit Couirf, and duplicat~ with Tax Assessor.)
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sc aooK200 ~E1247
~ No. 13 p
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