HomeMy WebLinkAbout2392 Declaration ot Domicile and Citizenship .
'~O THE STATE AND COUNTY TAX ASSESSOR, ~
Sl. IUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenshi~+ in the State of Florida that I am filing this day in accordance and
~n conformiy with Chapter 222, Section 222.17, Florida Statutes.
I was forme~ly a legal resident of __~1~~~~~K.~ -
(C;ty) (State)
and 1 ~esided at _.~1~1~1~~11~_~~__. - . However 1 have changed my domicile
(Street and Number)
~~~~L4~~J?~-C~ 1_ l~~ _ da of }
to and am and have been a bona fide resident of the State of Florida since ~ y x
- - - 19---, and 1 reside at ~l~ ~L~ 1 ~ - - -
(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 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.) ,
~E AN8
~SER POITR~~
RECORO YCRRFjEp CO
NM Z~ ~ ~l IW ~7Z
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~ I FURTHER CERTIFY that 1 will comply with al) other requirements of a legal resid~nt of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domi~ile, arsd I intend to remain in FORT
~ PIERCE, SAINT WCIE COUNTY, FLORIDA, permanently.
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~ - (Name)
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~ Sworn to and subscribed before me this day of 19 .
~
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~ ROGER POITRAS -
~ CLERK CIRCUIT COURT Notary Public
By ~ x~-~' D.C. My Commission expires
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(To be exscuted in duplicaM snd original filed with Cltrk Circuit Cour~, and duplicats with Tax Assessor.)
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OR y~.r ~
=~a' No. 13 A j~~ ,~WC~~~~
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