HomeMy WebLinkAbout0331 Declaration ot Domicile and Citizenship
23521;~
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FIORIDA:
This is my decla~ation of Domicile and Citizenship in the State of flo~ida that I am fili~g this day in actordance and
in conformity with Chapter ?22, Section 222.17, Florida Stat~tes.
I was forme~l a le al resident o _~Z _ _ _ _-._i'
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and I resided at _L~ 7~ _~v~"z ~f---~r„e~'-~~= ~ However I have changed my domicGle
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to and am and have been a bona fide resident of the State of Florida since _ _ day of
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- . 19~_Z and 1 reside at _ ~ % lX
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FORT PIERCE, SAINT LUCIE COUNTY, fLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or ~elinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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35212 ~
ST~IUC E COUNTr f~~
~~FRKG~ kCUIT COURT
Rf.CORD VfRIF1~0~~`_
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~ I FURTHER CERTIfY that I wil) 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 domiGle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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• ';`~,,J~` ,d~~`'~'~-~ ~•Cl~~2.r~`'~
_ , , . - . (Name)
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~ Sworn to and subscribed before me this day of ` , 19 ~ L.
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ROGER POITRAS
C K C CU{T COURT Notary Public
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~ ~y D.C. My Commission expires
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~ (To be executed in duplicate and original filed with Clerk Circuit Court, and duplicate with Tax Assessor.) =
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- BoaK ~05 PACE 331
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