HomeMy WebLinkAbout0457 Deciaration ot Domicile and Citixenship
TO TFiE STATE AND COUNTY TAX ASSESSOR, .
~35294
Si. IUCIE COUNTY, FIORIDA:
This is my declaration ot Domici~e and Cit~zenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter ?22, Section ?22.17, Florida Statutes.
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1 was formerly a legal reside~t of ~~1~~-!~-_---
(Ciy) (State) i
and 1 resided at ~~~a_ . 1~1Q.~1~__L~! 1C W 1~~.___.__ However ! have changed my domi~ile
(Street and Number)
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to and am a~d have been a bona fide resident of the State of Florida since ~~ta day of
_ 19__h~, and I reside at _~.l _ _ I ' ICj
7,~.~~-C~ ~k ~-L~-' '
~ - ~ (Street and Number)
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 Flo~ida.
(Insert here any pertinent facts, such as sale of property or busi~ess, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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235294
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I FURTHER CERTIFY that 1 will comply with all other requirements of a legat resident of this State.
1 FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE,.Si~~'~CU~J~ COUNTY, FIQRIDA, permanently.
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~ Sworn to and subscribed before me this day of , 19Z_Z
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~ ROGfR POITRAS
~ .LyERK CIRCUIT COURT Notary Public
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ey ~-2~``~ D.C. My Commission expires
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(To be execufed in duplicate and original filed with Clerk Circuit Court, and duplicate wifh Tax Assessor.)
~ doox 205 ~ACE 457
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