HomeMy WebLinkAbout2476 oec~arat~o~ o! Domicile and Citizenship z~311
TO THE STATE AND COUNTY TAX ASSESSOR, .
Sl. lUC1E COUNTY, FIORIUA:
This is my declaration of Domicile and Citizenship in the State of Flo~ida that I am filing this day in accordance and '
~n conformiry with Chapter ~2, Section 222.17, Florida Statutes.
I was formerly a legal resident of ---__~!C v r------- ---~~~v~~---
~ (City) (State)
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and 1 resided at _________rC~~ N( a~ ~y~ . However I have changed my domiCile
(Street and Number)
to and am and have been a bona fide resident of ihe State of Florida sinte __d.~~~ day of
_ 19~L_, and I reside at ~"L U ~R [V 1:, - .
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this stateme~t is to be take~ as my declaration of citizenship, actual lega) residence a~d domicile in the State of Florida_
(tnsert 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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: WCIE COUMTY ~
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~ 1 FURTHER CERTIFY that I will comply with all other requirements of a lega) resident of this State.
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; I FURTHER CERTIFY that I have ~o intention to return to my former domiule, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ _ V . ,..~f~•. - (Name M
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= - ~'/o ~ %~~~cn.~ ~G~~i~.u~~
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•j Swom~to and subscribed before me this day of 1:%~~ /CZu/c~ , 19 7~
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~~5 ROGER POITRAS _
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= ~L~RK CIRCUIT COURT Notary Public -
Y`j / ~
ys By ~ 'j'~ - D.C. My Commission expires
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~(To be ~xscuied in duplicate and oripinal filed with G~rk Ctrcuit Courf, aed duplicat~ with Tsx Assesfor.)
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