HomeMy WebLinkAbout2253 DeClaration ot Domicile a~d Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, .
Sl. WC1E COUNTY, FlOR1~A:
This is my declaration of pomicie and Citizenship in the State oF Florida that 1 am filing this day in accordance and
~n conformity w~th Chapter 222, Section 222.17, Florida Statutes.
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1 was fo~merly a legal reside~t of " ~
~C;ty~ (State)
and I resided at _ <<, p:;,,~L?-„~;,~ - However 1 have changed my domiCile .
(Street and Numl~er)
to and am and have been a bona fide resident of the State of Florida since ;`.1 - _ day of
•.-...~-.y ~~~1, n,...._.-~
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, 19__ , and I reside at - _ . _
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert he~e any pertinent facts, such as sale of prope~ty or business, or retinquishment of employment
at former domicile, removal of family to new domiciie, pu~chase of home, etc.) -
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Il`EO ~NO RECpRp~ >
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CLERK CIRCUI~Z~~~~~
11ECORD yER~i~fU
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I FURTHER CHtTiFY that 1 will comply with all other requirements of a legal resident of this State.
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I FURTHER CERTIFY thai I have no intention to return to my farmer domiUle, and I intend to remain in FORT
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PiERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ r~S~bm~tcs`and'subscribed before me this ~ day of ~-1~%'~~'' • •
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ROGER POtTRAS ` -
CLERK CIRCUIT COURT / Notary Public
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gy D.C. My Commission expires
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(To bs executed in dupliute and original ~iled with ~I~rlc Grcuit Court, and duplicats with Tsx Assessor.)
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