HomeMy WebLinkAbout2497 Deciaratio~ ot Domicile and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR,
51. IUCIE COUNTY, FLORIDA:
This is my declaration of Oomicile and Citizenship in the State of Florida that I am filing this day in accordance and
~n confo~mity with Chapter 222, Section 222.17, Florida Statutes.
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I was formerly a legal resident of . _ at.L - - - ~~L(•? _ 1sd~-_---' -
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and 1 resided at ~(L.. Q _ _ _ . However I have changed my domicile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _ day of
_ _ 19~~ and 1 reside at x ~ - -
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIOA
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 p~operty or business, or relinquishment of employment
at firmer domicile, removal of family to new domicile, purchase of home, etc.)
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' IIOCER ?OITRI?S
~~ERK Ct1CU1T COiI
RFCORO YERIi1ED
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1 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 1 have no intention to return to my former domitile, and I intend to remain in FORT
PIERCE, SAINT IUCIE COUNTY, FLORIDA, permanently.
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Sworn to and subscribed before me this 7~ day of a~~~ , 19
ROGER POITRAS
>=s K CIRCUIT COURT Notary Public
By t~i~~- • 1~ D.C. My Commission expires
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(To be sxscuted in duplicate snd oriyinal filsd with Utrk Grcuit Couirt, and dupliute with Tax A:s~ssor.)
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, 3 A ~~496
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