HomeMy WebLinkAbout2622 Declaration ot Domicile a~d Citisenship
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TO THE STATE AND COUNTY TAX ASSESSOR, • ~
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51. IUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship i~ the State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Flo~ida Stetutes.
I was formerly a legal resident of _ - - -Z'---
~ ' (Ciry) tate)
and 1 resided at However 1 have changed my damitilc
(Street a~d Number)
to and am and have been a bona fide resident of the State of Florida since ^~'!-~Z-_ day of
p~ ~
------a?Q . 19~~. and I reside at ~3 ~ ~"~t - 4
(Street and Number) ~
FORT PIERCE. SAINT LUCIE COUNTY, RORIOA
and this statement is to be taken as my declaration of citizenship, actual legal ~esidence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment t
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at former domicite, removat of family to new domicile, purchase of home, etc.)
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iT~ {~Clf COUNT1~RfL~ `
~OCEN POITRA= i
CLERK ClRCUIT COU '
RECORO YEAIFIEO ~
' MM ?9 II 17 ~11'TZ
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~ t RIRTHER ~ERTIFY that I will aomply with all other requirements of a legal resident of this State.
~ 1 FURTHER CERTIFY that 1 hav intenti t r turn t m f rmer d mi 'le and I intend to remain in FORT ~
e no on o e o y o o u, ~
PIERCE, SAINT IUCIE COUNTY, FIORIDA, permanently_ i
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Sworn ~to and subscribed before me this day of L;% i~~/Gr~,~.e~- , 19
ROGER POITRAS
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CLERK CIRCUIT COURT Notary Public
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By ' -'K~ ~.C. My Commission expires
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~:y= (To b~ ~x~cyhd in drplicat~ and ai~inai fil~tl wiN~ CIKIc Grarit Courf, and duplicat~ wiN~ Tax Ass~ssor.) ~
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