HomeMy WebLinkAbout2455 Declaration ot Domicile and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~~~~n,p•~ j
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Sl. WCIE COUNTY, FIORIDA: ~
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This is my declaration of Domicile anci Citizenship in the State of Florida that I am filing this day in accordance and
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~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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I was formerly a legal resident of ~YPr_~t ~1_~~----- - - - ~ c-~-_
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(City) (State) ;
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and 1 resided at ,rT'~ t'`~~~..~P'~~~11~~ ~7~~ However 1 have changed my domic,ile
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(Street and Number) ~
to and am and have been a bona fide resident of the State of Florida since _ `Y ~ V _ l~ ~~T l ay qf
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, 19--- . , a~d I reside at _ - i/~'~" ~ -~~0 ~"l ,
(Sfreet and Number) 33 ~s~
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
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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.)
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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 CfRTIFY that I have no intenfion 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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~$wor~ to and subscribed before me this day of , 19 .
ROGER ~OITRAS -
CIRCUIT COURT Notary Public
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" By _ O.C. My Commission expires
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z~' (To b~ sx~euMd in duplieat~ and ori~inal fil~d wilh Cl~irk Grwh Court, and duptieats with Tax Asssssor.)
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aooK20U ~~E2454
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No 13 q
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