HomeMy WebLinkAbout0159 Declaration ot Domicile and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR,
Si . IUGE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Ftorida that I am filing this day in accordance and =
~n conformity with Chapte~ 222, Section 222.17, Florida Statutes.
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1 was forme~ly a legal resident of _~Q~~
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C C~. G _~/4 L___ _ t~ _
(City) (State)
and 1 resided at 1~~ ~/R~~Y'~ 1~~" However I have changed my domiCile
~ (Street and Number)
to and am and have been a bona fide resident of the State of Florida since ~ L _ day of ~
~ - ~ ~
. 19~ and I reside at ~ 11~/} V~) 1 U Z,
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and ihis statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
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(Insert here any pertinent facts, such as sale of propery or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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FIlEO Ayp RECORpEO ~
ST. tUCIE COUNTY F~~. -
CLE K~C'~;,(~j~T COURT
RECORL vER:FiEp~y~
AIIG I ~ ~ I 0? AM 'TZ
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I FURTHER CERTIFY that I will comply with al) other requirements of a legal resident of this State.
I FURTMER CERTIFY fhat I have no intention to return to my former domi~ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORI~A, permanently. ~
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~ (Name) ~
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~ ~ ' - " . ' ~C SOLl1~ ~ ~o ~ST uclL`- ~
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~ . . (Address)
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~ Sw ~n t`J•and subscribed before me this O( da of U~ 19~ ~
~ or o y .
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~ ROGER POITRAS , _
RK CIRCUIT COURT Notary Public ?
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~ By `t-~-'~ ~ ~C~~ D.C. My Commission expires _
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(To be executed in duplicate a~d origina) filed with Clerk Circuit Court, and duplicate with Tax Asseswr.) ~
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