HomeMy WebLinkAbout2706 Declaration ot Qomicile and Cltizenship ~%264~a3
TO THE STATE AND COUNTY TAX ASSESSOR, , .
Sl. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship 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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I was formerly a legal resident of _~C Y!
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~C;ty~ (State) ~
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and 1 resided at ~ ~ Y~''~~{~ ~t~q!+'~J'S__._ _ However I have changed my domiCile
(Street and Number)
ro and am and have been a bona fide resident of the State of Florida since ~ y~~} _ _ day of
~/v'~~ !~v' 19_T and I reside at 1s1.~7._~~~!!llJyo~~~:a~~ ~~/f', TlMi~• Bta~l~- -
(Street and Number) ~
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 pe~tinent facts, such as sale of property or business, or ~elinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.) !
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~ I FURTHER CERTIFY that I wil) comply with all other requirements of a legal resident of this State.
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~ I FURTHER CERTIFY that I have no intention to refum to my former domi~ile, and I intend to remein in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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~ - ~ Willard ~~~'~CCPtbe '
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~ ~ o- l30 ~ y y, ~~~s~~, A~ k ~~3 ys
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~ ' ~Swom to and subscribed before me this day of
ROGER POITRAS -
_ K CIRCUIT COURT Notary Public
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By G~-~-L__~~~-~`~ D.C. My Commission expires
- (To be executed in duplicats and original filed with Cleric Circuit Court, snd duplicate with Tax Assessor.)
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- ,+o. 13
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