HomeMy WebLinkAbout2449 Deciaration ot Domicile a~d Citizenship
2~6295
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of `_-`~_~i_~ ~'s
~U~ v - - _ ` -
(City) (State)
and I resided at 6 d o . However I have changed my domiGle
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since f~ _~T • day of
`~c~,~c~c_ ~.-'u 19---, and 1 reside at b~ p v~- fT ~ e I~{ ~p~ -
. ~ (Street and Number)
FORT PIERCE, SAINT LUCIE CQUNTY, FLORIDA
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 family to new domicile, purchase of home, etc.)
~~[~,~.~~t,c~t.~ /~~l-~-C~,zc.~-r
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, r ~fo ~?MO RECORpti
lUC1E COUNT~ fLA.
lIOCER POITRAE
CIERI( CIRCUIT COURT
RECORD VERIFIEO~~...
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~ 1 FURTHER CERTIFY that I will comply with all other raquirements of a legal resident of this State.
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~ I FURTHER CERTIFY that I have no intention to retum to my former damicjle, and 1 intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanentiy.
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. . . . ~ (Name)
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- _ (Address)
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. . . ' ~ v~ ~ c"[.~.,~t/ /y
'~:,,~inJcfin.to and subscribed before me this day of , 19L~ ~
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ROGER POITRAS ~
CL~K CIRCUlT OURT Notary Public `
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F' 8y L~ ~'~~`~~t'~ D.C. My Commission expires
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Ro bs ~xecutsd in duplicat~ and ori~inal filed with Cl~rk Grcuit Court, and dupliut~ with Tax As:essor.) ~
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