HomeMy WebLinkAbout1290 Declaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, ' 2254'79
Sl. WCIE COUNTY, FIORIDA:
This is my detlaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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I was fo~merly a legal resident of , _ . -
(Ciy) (Sta
and I resided at~~_~~ _ ~ ~ . However 1 have changed my domitile
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(Street and Number) , ~
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ro and am and have been a bona fide resident ot the Staie of Florida sinc day of ?
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-~i~wc~fi-- 19 , and 1 reside at l0~_~~ ,~fLLsn-t~ - ~
~ (Street and Number) ~
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FORT PIERCE, SAINT LUCIE COUNTY. FLORIDA F
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and this statement is to be taken as my declaration of citizenship, adual 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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2254'79 ~
F11E0 At10 RECORQEp
St.lUC1E COUNTY flA.
ROCER P017RAS
CIERK Ct~CU1T COURT
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" I FURTHER CERTIFY that I will comply with all other requirements of s leyal resident of thia State. ?
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~ I FURTHER CERTIFY that I have no intention to return to my former domic.ile, and I intend to remain in FORT ?
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~ PIERCE, SAINT.L~tiG{~ ~OUNTY, FLORIDA, permanently. ~ ~
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' ~ (Name)
~ ~.r ~ k~arie E. l~c Aninle~ ;
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; Sworn to and subscribed before me this day of , 19~. ~
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ROGER POITRAS '
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~ LFitK CIRCUIT COURT Notary Public
- 8y D.C. My Gommission expires i
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~ (To b~ oxsn+ted in duplicat~ and oripinal ~iled with GKk Cirwit Courf, and duplicsh with Tax Aswstor.) ~
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