HomeMy WebLinkAbout0332 ~
Decla~atian ot tDomicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FIORiDA: ~ 235213
This is my declaralion of Domicile and Cilizenship in the State of Florida that 1 am filing this day in accordance and
~n conform:sy with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of r J~ ~~L~~~d'` I ~~C-M~` -
(Ciy) (Sta
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and 1 resided at _~_Q~_~[8, . L However 1 have changed my domiCile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _1f __~~~Z _ _ day of
~~,,~r r
19---• and 1 reside at _1~1Z~ f ? ~~L /`:c~C~r.~= ~
(Street and Number)
FORT PIERCE, SAINT IUCIE COUNTY, fLORIDA
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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~ 235213
FILEO AMD RECOROEO
ST. LUCIE COUNTY FtA.
RaCEA FOITRAS "
CIERK CI~iCUIT COURT
RECdRO YER~FtEp_.~~ .
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~ I FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domic,ile, and I~~tend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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Sworn to and subscribed before me this day of ~ , 19~_.
/
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~ ROGER POITRAS
~ ; C CIRCUIT COURT Notary Public
~ ~y ~~u'~`~~ ~`Z'~`-~~ D.C. My Commission expires
~ (To be executed in duplicate snd original filed with Clerk Circuit Court, snd duplicate with Tax Asseswr.)
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~ , , 80RK ~5 PAGE 332
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