HomeMy WebLinkAbout1162 Decla~ation ot Domicile and Citisenship .
TO THE STATE AND COUNTY TAX ASSESSOR,
" 233620
51. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Ftorida that 1 am filing this day in accordance and
~m m~formity with Chapter 222, Section 222.17, Florida Statutes.
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1 was formerly a legal resident of ~~~~~~~s_~~
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(Ciy) (State)
and 1 resided at ._1__,[_~ ___~~^5~~~~~-~v~ _ However 1 have changed my domiCGle
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since %X_~_____ _ day of
/
19~~, and I reside at L~al c~ Nl~l SF ~~.I ~
~ (Street a~d Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA '
and this statement is to be taken as my declaration of citize~ship, actual legal residence and domicile in the State of Florida. ~
(I~sert here any pertinent facts, such as sale of property or business, or relinquishment of employme~t
at former domicile, removal of family to new domicile, purchase of home, etc.)
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233620
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I FURTHER CERTIFY that I will comply with al) other ~equirements of a legal resident of this State.
1 FURTHER CERTIFY that I have no intention to return to my former domicrle, and I intend to remain in FORT
PIERCE, SAINT LUClE COUNTY, FLORIDA, permanently.
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`•2~'~~ (Name)
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^ Sworn, to and suburibed before me this ~ day of - , 19'
ROGER POITRAS
CIRCUIT COURT Notary Public
By`' ~ D.C. My Commission expires
(To be ~xecuted in dupliute and originsl ~ilsd wilh Gerk Grcuit Court, and dupliute with Tax Assessor.)
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