HomeMy WebLinkAbout0732 Declaration of Domicile and Gitizenship
~ 235498
TO TFiE STATE AtiD COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FLORIDA:
This is my declaration of Uoniicile and Citizenship in the State of Florida that 1 am tiling this day in accordance a~d
~n cun{ormi?y with CFiapter 222, Se~tion 222.17, Florida Statutes.
1 was formerly a leyal resident of -.(~L'G7-~~----------------- --~~~=l-~-~'~4L~~------
~C;ty~ (State)
and I resided at ~qA~--GA~ST__-~~n However I havechanged my domiu~P
~ (Street and Number)
to and am and have been a bona fide resident of the State of Florida since .~ILl~.-- day of
19~-, and I reside at ~7~ .-~~~1~I~~~C'G . d~ ~Q_~-- - - j
(Street and Number) ;
~
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA ~
and this statement is to be taken as my declaration of citizenship, actual legal residence a~d 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, ~emoval of family to new domicile, purchase of home, etc.)
eaRr
flLEO ANO RECOROEO
ii.luC~E COUMTY fl~- ~ ,
ltOCcR P~iTl1AS ~
' CIERK C1:~U~T COURt
Pf!'ORP Vf?•FIEO
auc ~6 ro 35 AM ~~Z
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~ 235498
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
1 FURTHER CERTIFY that I have no intention to ret~srn to my former domi~ile, and-I intend to remain in FORT
PIERCE, SAtNT LUCIE COUNTY, FIORIDA, permanently.
~
(Name) 8 a K ~
~ ~ - ~ ' ~ ~ .
~~~`,lJ .fGi.~~ r.~' ~G~ ~Cv7~ g
~ . T'~ ~ (Address)
~ .
~ Sworn to and s~bscribed before me this _ day of , 1q ~ L
~ ° ~ .
.
ROGER POITRAS -
CLERK CIRCUIT COURT Notary Public
\
~ By - D.C. My Commission expires
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(To be oxecuted in duplicate and original filed with Clerk Circuit f.ourt, and duplicato with Tax Assessor.)
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