HomeMy WebLinkAbout2891 Y ;
Declat~aticn ot Domicile and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR, ~ :
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51. IUCIE COUNTY, FIORIDA:
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This is my deciara~ion of Uomicile and Citizenship in the State of Florida that I am iiling this day in accordance and '
~n confarmity with Chapler 222, Section 222. i 7, Florida Statutes.
I was formerl a te a! resident of -C~`~-?.-_~"'_-`---- V~
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(City) ( tate)
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and I resided at However 1 have changed my domiCile
(Street and Numbcr)
to and am and have been a bona fide resident of the State of Florida since _ _ day of
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~ and I reside at _ ~ O ! ~ 6~~ " . ~ ~ ~A9~' !
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FORT PtERCE, SA1NT LUCIE COUNTY, FIORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in ihe State 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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234886
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~UCIE COUNTY FLA.
ROCER POITRAS - ~ i
CIERK CIRCUtT COURT '
RECORD YfRtF~ED.~~
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I FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State. t
I FURTHER CERTIFY that I have no intention to return to my former domiGle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. • ~?~LOVl C. YILI,ARD JR . -
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(Name)
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~ = 8th August ~72
~ = SOv~ U~,~cribed before me this day of , 19 .
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1~ ~d~JR1 Notary Public
~y • D.C. My Commission expires
(To be executed in duplicate and original filed with Clerlc Circuit Court, and duplicate with Tax Assessor.)
. , 3 a~ 204 ~ 2890
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