HomeMy WebLinkAbout0840 Declaration at Domicile and Citiz~nship
TO THE SiATE AND COUNTY TAX ASSESSOft. 2355~1
Si. IUCIE C.OUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in acco~da~ce and
in conformity with Chapter 222, Section 2??.17, Florida Statutes.
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1 was formerly a legal resident of -
(Ciy) (State)
and 1 resided at _~_~G However I have changed my domiCile
G~ (Street and . Number)
to and am and have been a bona fide ~esident of the State of Florida since __7=_~
3-_~ y_ ~ _ day of
- - - 19~__ , and I reside at L -3~~~.SC~P1~~~~~~_l~~
, (Sireet and tJumber)
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~se~t 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.) ~
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I 2355'~1
I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State. .
I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend fo remain in FORT
PIERCE, SAINT LUCfE COUNTY, FLORIDA, permanently. pA~ j,ECHI,EITER
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.a,~~.a. ~lit~~
~~..••v{T (Name)
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y~~,~' ~ ~ ~
' + ~ = ~ 2023 St . Luc ie Bl~d . , Lot 9 ~
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- _ ~ ' ~ = (Address)
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: ~ , : v, 72
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~'•.,~l~~~n~o~a~~subscribed before me this ~ 7t~ day of AuBust ~ 19 . ~
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ROGER POITRAS ~
CLERK CIRCUIT COURT Notary Public i
.
8y D.C. My Commission expires
(To be executed in duplicate and original fiied with Clerk Circuit Court, and duplicafe with Tsx Assessor.)
Bo~K ~~J PA~E 840
~ry
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