HomeMy WebLinkAbout0274 Declaration o1 Domicile and Citizenship 2351,~ J
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. WCIE COUNTY, FIORIDA:
This is my decla~ation of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter ?22, Section 222.17, Florida Statutes. ~ ~
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1 was formerly a legal ~esident of ~~~~rj._~. j' ~ ' `'~-~u/ ! b ~ `
(City) (State)
and I resided at -_I L~~ ~ ~ V e' Howeve~ I have changed my domiCile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _._~V' day of
~~b ~;1 s r. - P~r~t st, L~~,~,
_ , 19~, and I reside at
(Street and Number)
FORT PIERCE, SAINT IUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actuat legal residence and dornicile in the State of Florida.
(Insert he~e 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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2351'75
, FIIE~ ~ND RECORDED ~
ST. LUCIE COUMTY FLA. ,
ROCEk ?~ITRAS
CIERK C=~tCUIT COURT
~ RECOR~ V~~~FiEp~~~
` Auc ! I 12 z3 PM'?Z i~
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
1 FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~~i't/ ~~.~2~
' _ (Name)
' " • ~ ~
~ , , - .
~ ' _ (Address)
~ ' • ~iL ~
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~ ~ ,J `flnro~n to `and subscribed before me this day of ~ , 19~ .
~
~ / -
~ ROGER POITRAS
~ C K CIRCUIT COURT Notary Public
~ By . D.C. My Commission expires
(To be executed in duplicate and original fited with Clerk Circuit Court, and duplicate with Tax Assessor.)
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~on~ `~l05 ~a~t ~7~
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