HomeMy WebLinkAbout0214 ~eclaration ot Dor~icile and Citlsenship
;~32981
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FLORIDA:
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This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal ~esideM of C2~-c~~~ -
(C~ ) ~ (State)
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7 ~t-~ ~d~- However I have chan ed m domiCile
a~d 1 resided at ~ ~ 9 Y
(Street a~d Number)
to and am and have been a bona fide resident of the State of Florida since v"-`~~="'`~- _ oZ day of
1 ~~d~Q •
19---, and I reside at ~~_L~f~'L;N~t~x~.d --lQ-L. ~7~2X
(Street and Number) ~
FORT PiERCE, SAINT LUCIE COUNTY, RORI~A
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 pertine~t facts, such as sale of property or business, or relinquishment of employment
at forme~ domicile, removal of family to new domicile, purchase of home, etc.)
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ROCEa POItR~~
CLERK CIRCUlT COt1Rt m~
RECORD YER~FIED.....~i.
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i 232981
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I FURTHER ~ERTIFY that 1 will comply with all other requirements of a(egal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SqIN~~li~~,E ~OU~,tTY~ FIORIDA, permanently.
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~ Swom to and subscribed before me this day of , 19~-L
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~ ROGER POITRAS
CIERK CIRCUIT COURT Notary Public
By l D.C_ My Commission expires
(To b~ ~x~cw~d in dupliuts snd ori~iaal filed wiN~ CIKIc Grarit Court, and dupliuts with Tax Assessor.) _
~LRK ~O~ PAGf ~~,4
Plo. 13 q
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