HomeMy WebLinkAbout1547 Decla~atlon ot Domicll• and Cltizenship ~
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TO THE STATE AND COUNTY TAX ASSESSOR, .
Sl. IUCtE COUNTY, FLORIDA:
This is my declaratio~ of ~omicile and Citizenship in the State of Flo~ida that 1 am filing this day in ecco~dance and
~n oonformity with Chapter 222, Section 222.17, Florida Statutea. i
1 was formerly a legal resident of - Gi~~ ~~-~~lJ -
~ty) (State)
and I resided at -~~__-2 ~ ` However I have changed my domiti~e
(Street and Number)
to and am and have been a bona fide resident of the State of Florida si~ce _1~-_----~f- ~ 9 7l day of
. 19--, and I reside at ~ L~/ ~
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
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 aale of property or business, or relinquishment of employment
at former domicile, removat of family to new domicite, purchase of home, etc.)
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~ f R/RTHER CHtTIFY that I will oomply with all other requirerrients of a lepal resident of this State.
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~ 1 FURTHER CERTIFY that 1 have no i~tention to return to my former domicjle, and I intend to remain in FORT
~ PIERCE, SAINI LUCIE COUNTY, FLORIDA, permanently.
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(Name) / P~~i D
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' ~C~G;~ 1..... ' (Address)
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a Sworn to artd subscribed before me this day of ~'~C'~ , 19 i
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~ ROGER POITRI?S
CLFRK C{RCUlT COURT Notary Public -
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~ By ~k~~~ D.C. My Commission expires
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~ (To b~ uaevl~d in duplteat~ aed o~nal fll~d wilh Cl~elc Cireuif Cowf, aed duplied~ wilb Tax Ass~or.)
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