HomeMy WebLinkAbout0503 Declaration ot Domicile and Citizenship ~
TO THE STATE ANO COUNTY TAX ASSESSOR, 235323
Si. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and ~
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~n conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of u~- 6 ('N O' A'V A
(City) (State)
and I resided at ~0 7-_ ~ H ~ Q- • However 1 have changed my domiCile ~
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to and am and have been a bona fide reside~t of the State of Ftorida since _ day of
-~~L~~--- 19_33e, and I reside at ~~S D~~A~,t) P4~ t~ c~,~ r i•~~E e~ r"-r~i A i
(Street and Num er)
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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.
(I~ser1 here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, ~emoval of family to ew domicile, purchase of home, etc.) i
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FILEO AM~ RECOIiOfp
=t.IUCIE CQUNTY fL~
ROCEei ~OITRA$
CLERK C~ :CUlT COORT ~
~RECORD vErt~FrED
~ a~ ~s ~0 4~ a~ ~7Z
! 2~5323
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
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I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
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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 , _
CLERK CIRCUIT COURT Notary Public
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~ By ~S~- ~ D.C. My Commission expires
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(To be executed in duplicale and original filed with Clerk Circuit Court, and duplicate with Tax Asseswr.)
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