HomeMy WebLinkAbout0517 Declaration ot Domicile and Citizenship
235335
TO THE STA1 E AhD COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
This is my declaration of Uom~cile and C~tizenship in the State of Florida 1ha1 I am filing this day in accordante and
in conforinity with Chapter 222, Section 22?.17, Florida Statutes.
I was formerly a legal resident of ~OUN~ _ l~o~G#/ _ , _ _ . _ NPt~CTt'.e s,e~ _ _
(C~ty~ (State)
and 1 resided at _~LQYr~- !~~_4~ G~_..ccs_ia_~Ttfe~L~~n/~T _ However 1 have changed my domiCile
(Street and Number)
to and am and have been a bona fide ~ssident of the State of Florida since -_~_Q~_.----------- day of
FT_ ,J E~,_ ff8_.._
19.~~., and I reside at A~~_~-~I~F~f
(Street and Number)
FORT PIERCE, SAINT LUCIE C~UNTY, 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 periinent facts, such as sale of property or 6usiness, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
/~fL.qA/ic ~EA.{/NJ9 ~/~'~~iC/-
FtLED AXp !tE
ST.i~iC1E C8'IA~~~
ROCEA POIT~ 1P
C1ERK CIRCW~ ~T
RECORO VEq~FIEB.......~~~
Ar~ ~a ~'I'~Z
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~ 235335
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1 FURTHER CERTIFY that 1 will mmply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that 1 have no intention to return to my former domi~ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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` . (Name)
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` Sworn to and subscribed before me this ~-S day of , 19~J~
ROGER POITRAS _
CLERK CIRCUIT COU Notary Public
ey ~ ' G'~ 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 AsseswrJ
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~ b~K 205 PA~ 51?
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