HomeMy WebLinkAbout0839 Declaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~~55~0
Sl. IUCIE CQI~NTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
in conformity with Chapter 242, Section 222.17, Florida Statutes.
I was formerly a legal ~esident of _~,Q~~ 1-~-~~
(Ciy) (State
and I resided at i2't~_ ~._l___~L'~_Q.LQl7~~ However 1 have changed my domiGile
• (Street nd Number)
to a~d am and have been a bona fide resident of the State of Florida since ~ 1~ day of
`
,~aZ~~I.S/_-. 19~2~.and I reside ai v0~/o ~~iP.PAC
(St~eet 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 ~roperty or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
7r-e ed~a-~:~ °t ~,,.7`4, G~~c~. y- - .~Z~~''''Q.
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FtLEO ANJ RECORDEO
St_ IUCIE COUNTY FLA.
itOCER FOITRAS m
CtERK CikCUtT COUNT ~
• RECGRD YER+FIEO~~-•~--
. ~ ~a~ ~i 4~ aM ~7z
, 2355'7O
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I FURTHER CERTIFY that 1 will mmply with alt other requirements of a(egal resident of this State.
1 FURTHER CERTIFY that I have no intention to return to my former domi~ile, and 1 intend fo remain in FORT
PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently. JOAl~" C. LliC
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( me)
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ribed before me this day of , 19
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' ROG'ER' PO~ITRAS
RK CI UIT COURT. Notary Public ~
By ~ ~ D.C. My Commission expires
~ (To be executed in duplicate and original filed with Clerk Circuit Court, and duplicats with Tax Assessor.) _
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