HomeMy WebLinkAbout2413 Declaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, • ~L?r~,~U
V~r V
51. LUCIE COUNTY, FLORI~A:
This is my declaration of Domicile and Citizenship in the State of Flo?ida that 1 am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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1 was formerly a legal resident of -
(Ciy) (St )
and 1 resided at ~~u'u'~D~ - However 1 have changed my domicjle
(Street and Number)
~ da of
to and am and have been a bona fide resident of the State of Florida since _ ~ o_--- - Y
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- 197!~, and I reside at ~J~~~ ~ 3 2 ~~'~_"""='-~`J
(Street and Number)
i~ORT 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 oE Florida.
(Insert here any pertinent facts, such as sale of prope~ty or business, or relinquishment of employment ;
at former domicile, removal of family to new domicile, purchase of home, etc.)
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FILEO AMD RE~~
'3T. LUCIE COU ~
ROCER POITRAS
CIERK CI~CUIT CObIIT ~ ~
RECORO YERIFIfO~..
~ ~Y ~ ~105 P!I'1I
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t 225269
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~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State. ~
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~ I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT ~
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~ PiERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. `
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y ~ ~ R
~ i , . (Name) .
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_ ' ' _ _ .
l~ ' • ' ' . . ~
_ . . • Y (Address) ;
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,t 'Sae~orri.fo=~~d''subscribed before me this ~ day of ~ . 19~~Y
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- ROQER POITRAS ~
CLERK CIRCUIT COURT / Notary Public ~
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By ' D.C. My Commission expires ;
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(To be sxecuted in duplicate snd originil filsd with C{~rk Grwit Court, snd duplicat~ with Tax Assessor.) ~
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~~K ~o , 3 A BooK ~00 PA~2412
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