HomeMy WebLinkAbout0578 Declaration ot Domicite and Citizen~hip 235369
TO THE STATE ANO COUNTY TAX ASSE:S.`~O!2,
~l. LUCIE COUNTY, FLaRIDA~
This is my declaratiun of Qomic~le and Citizenship in the Statc of Florida that i am fii~r~g this day in accordance and
~n confonnity with ChaF~ter ?22, Section 2?2.17, Florida Statufes.
I was formerly a legol residenf of - -f!!P~l~ - - _ - _ _ _ . - . ' X'~ -
(City) (State)
and I resided at _~00 ~_._~~E~1(/V_~~S . Howeve~ 1 have changed my domi~ile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _ day of
~
_ !~fC/ ll S - - 19
~ Z ; and 1 reside at _~/s • _ ~~E /4~/Q _
(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 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.)
~ ~D~iN ~•C~~H~
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235369
r1~EC ~?NU aECOR~to ~
~iT.lUC1E COUMTY tA.' ~ -,l -
ROGER ?O~TRAS _(~7'U'''
CLERR CinCU1T COIIRT ~~,Y
RECORO YER~FIEO
Ilnc 15 4 zs PM ~~z ~
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1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of ihis State.
1 FURTHER CERTIFY that I have no intention to return to my former domiCile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ / ~ ~ Q~~~•L ~
~ (Name)
~ ~ ~ hl u~. ~1o~F s~~
~ ~ (Address)
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~'C~
~ ~~:.•''$wom~to.and subscribed before me this l~ day of , 19 / _
~ 7 •
~ - ROGER PC~~TRAS _ _
- . LERK CIRCUIT COURT Notary Public
~ gy - D.C. M Commission ex ires
_ ~ Y P
(To be oxecufed in duplicate and ori~~k i~Ele uit Court, and dupliwto with Tax Asseswr.)
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