HomeMy WebLinkAbout2329 Declaration ot Domicile and Citizenship 2~6~ j~ •
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCiE COUNTY, FIORIDA:
Th~s is my declaration of Dom~cile and Citizenship in the State of Florida that I am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes. '
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I was formerly a legal resident of . ~(~__.~1QLL. ~
(City? (Stat~J
and I resided at _~_~_Q _ ~ Howeve~ I have changed my domiCile
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(Street and Numbe~)
ro and am and have been a bona fide resident of the State of Florida since lste4t _ l~Z~day of ~
~ _ y, ~~L
- _ - 19~~, and 1 reside at l~_-7 ~~--~T~~- ~~'~~P
(Street and Number) ~
FORT PIERCE. SAINT LUCIE COUNTY, RORIDA ~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
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(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of fami~y to new domicile, purchase of home, etc.)
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FI~EO AND RECQ_RQE4
iT. LUCtE COUMrr RA.
ROCER POITRAS .
CtERK C1RCU1t COIIRT
RECORO YERIFIED '
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~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State. y
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~ I FURTHER CERTIFY that I have no intention to retum to my former domiule, and 1 intend to rema n in FORT
~ PIERCE,~ SAIh~T. ~UCIE COUNTY, FLORIDA, permanentty.
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- . ~ (Name) C.~: /v~~ ~e/ ~
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Sworn to and subscribed before me this day of 7~ /<<?~~~- , 19 7~,. ~
sh _
~ ROGER POITRAS
~~r CLERK CIRCUIT COURT Notary Public :
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y D.C. My Commission expires
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~F-;. (To be executed in dupliuts and ori~inal ~iled with Cl~rk Grcuit Courf, and dupliute with Tsx Assessor.) '
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