HomeMy WebLinkAbout0724 y~ ~
Declaratio~ ot Dornicile and Citisenship ~
,
• TO THE STATE AND COUNTY TAX ASSESSOR, ~ 233308 ~
Sl. LUCIE COUNTY, FIORIDA:
This is my dedaration of Oomicile and Citizenship in the State of Flo~ida that I am filing this day in accordance and
in conformity with Chapter 222, Sectio~ 222.17, Florida Statutes. ,
I was formerly a legal resident of ____~_~~!~~L ~~~~~`-N~~=~~ - t
(C~y) (State) ~
and I resided at ~ . However I have changed my domi~ile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida sincc day of
--/.'%L_~y
- 192~-. and I ~eside at 11~ ~~/T'(= ~f
l/~~ -
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken a$ my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, suth 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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! ~33308
I FURTHER CERTIFY that I will aomply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my forme~ domic,ile, and 1 intend to remain in FORT
- ?
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ - ~ ~ ~1` (Name)
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Swom to and subscr~bed before me this day of , 19Z_'-
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ROGER POITRAS
CIRCUIT COURT Notary Public
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_ By ~ G`~`'~`"~ D.C. My Commission expires ~
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(To bs ~xecut~d in dupliuto and ori~inal ~I~d with G~~lc Grcuit Court, and duplicate with Tax Assessor.)
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No. 13 A ~~uK ~0"~ PACE ~
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