HomeMy WebLinkAbout2484 Declaration ot Do~niCile and Citizenship
TO THE STATE ANO COUNtY TAX ASSESSOR,
51. LUCIE COUNTY, FLORIDA: ~4`fJ
This ~s my declarat~on of Domicile and Citizensh~p in the State of Florida that I am filing this day in accordance a~d
~ n conformity with Chapter 222, Section ?22.17, Florida Statutes
I was formerly a legal resident of J!Qz-t~ -~Gz%~ G"-~~=n--'-
(Ciry) (State)
and 1 resided at ~-~Sf ~ f3l ~ a4i ~Ct /GQ!_~-c~~ However I have changed my domicjle
(Street and Number)
fo and am and have been a, bona fide resident of the State of Florida since ~c,' day of
, 19_?~. , and I reside at 7,~a1G,t h_~-~c-S-~~-r=1•r-~+~ ~ S~
(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 ~ate of Florida.
(Insert 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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I FURTHER CERTIFY that I will comply with all 'other requiremenis of a legal resident of this State.
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I FURTHER CERTIFY that I have no intention to refurn to my former domiule, and i iniend to remain in FORT i
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PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ `S f~~~`~and subscribed before me this day of , 19 7~
~ ~.tIC.. L. •`O'
~ ROGER POITRAS
~ CLERK CIRCUIT COURT Notary Public ~
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~ By ~«~-~-y1 D.C_ My Commission expires
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(To be executed in dupticate and original ~led with Clerk Circuit Court, and duplicate with Tax Assessor.)
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