HomeMy WebLinkAbout0158 Declaration ot Domicile and Citizenship
. 235n'79
TO THE STATE AND COUNTY TAX ASScS50R,
Si. LUCIE COUNTY, FIQRIDA:
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This is my declaration of Domicile and Citize~ship in the St~te of Florida that 1 am filing this day in accordance and ~
~n conformity with Chapter 222, Section 222.17, Flor~da Statutes.
I was formerly a legal resident of t___~!?
~~~~LE _ r~-G''~~~ _
(C;ty) (State)
~ ~H~~ . However I have chan ed m domicjle
and I resided at _L~•~' 9 Y
(Street and Number)
to and am a~d have been a bo~a fide resident of the State of florida since day of ,
T 7l0 ~1/ tL /llA.e ~•P~v~ -~~E'/~L..~! L~cv.3 y
~-v`~~?E~ 19~9 and 1 reside at .~uTC~~~iv s~ T=sc ~~U~
(Street and Number)
FORT PIERCE, SAINT LUCfE COUNTY, fLORIDA ~
and this stateme~t is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
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(Inse~t here any pertinent facts, such as sale of property or business, or relinquishment of employment ~
at former domicile, ~emoval of family to new domicile, purchase of home, etc.)
~,~~r~.e ~ ~v~ Gr.s~~ ~ n ~.v S~ ~
. 235~~9 ;
fIlEO AND RECORDEO
SL ~uCIE COUMTY F(,~_ - -
~ CLE KcC ~CUIT COURt
RfCORO VEA~FIE~J-
I ~G 10 j ~ 8S ~'71
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~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY fhat I have no intention to return to my former domic,ile, and 1 intend to remain in FORT
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RIERCE, SAINT j,UC1E COUNTY, FLORIDA, permanently. `(J, ~~~~Q~ ~
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~ Swom to and subscnbed before me th~s day of , 1 ~
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ROGER POITRAS =
C CIRCUIT COU i Notary Public
g~ C~C~t
t~ C%`G~~ ~
D.C. My Commission expires
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(To be executed in duplicate and original filed with Clerk Circuit Cou?t, and duplicate with Tax Assessor.)
BOOK ~ PACE
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