HomeMy WebLinkAbout2478 ~r~rvViV
Declaration ot Domicile and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSqR,
Sl. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenshi~ in the State of Florida that I am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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1 was forme~ly a legal resident of G~i'lS..~C1~_ ~~w _-~-~~S
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(City) (State) `
and I resided at ~.4~~~~~5~~__~~
L~-__ _ _ . However 1 have changed my domiGile
(Street and Numbe~)
to and am and have been a 6ona fide resident of the State of Florida since~V~Tia._ ~4~~ _ day of
4 F,.~.'~'~`~~~..'~ 19
~_Q, and I reside at ~
L-Ga N v T sL
(Street and Number) ~
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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 emptoyment
at former domicile, removal of family to new domicile, purchase of home, etc.) ~
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226313
~~~EO ,?NQ eECOa~t~
j~ IIOGER POTRAS '
CLERK CIRCUIT C ~
RECOR~ Vf RIFIEO
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~ I FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State. f
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I FURTHER CERTIFY fhat I have no intention to return to my former domic,ile, and ( intend to remain in FORT ~
~ P!ERCE, SAfNT LUCIE COUNN, FLORIDA, permanently. AI,BEI~T G. bQOO~Y i
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>4 (Name)
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- ~ ~ ~ . (Address) 0~3 S~
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Sworn'to and ~subscribed before me this Z 7 day of ~ ~ C H , 19 ~
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- ROGER f~O1TitAS
- CLERK R COURT Notary Public
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By D.C. My Commission expires ~
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4;' (To be sxecuted in duplicat~ and oripinal filsd with G~rlc G~cuit Couirt, and dupliate with Tax As~es~or.) ~
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