HomeMy WebLinkAbout0850 ~eCla~ation ot Domicil~ and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, 23S5~S
Sl. lUC1E COUNTY, FIORI~A:
This is my declaration of Domicile and Citize~ship in the State of Florida that I am filing this day in aocordance and
in conformity with Chapte~ 222, Sectio~ 222.17, Florida Statutes. ~
I was formerly a legal ~esident of -~~v~ -
(City) (Stab)
and I resided at !J.
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C~__ 3 However 1 have chsnged my domitile
(Stree and Number)
to and am and have been a bona fide resident of the State of Florida since - 7L_- day of
- - - . 19 and 1 reside at ~ ~ ~ ~ - ~ ~c ~
(Sheet and Number) r~ • p
F~tT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legat 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.)
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~ FILED AND RECORDEO
~ ST. ~UCIE COUNTr FIA.
ROCER POITAAS
~ RECdRO YERRF ED COURT ~ ~~~~~8
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1 RJRTHER CERTIFY that I will oomply with all other requiremenis of a leyal resident of this State.
I FURTHER CERTIFY that I have no intention to retum to my former clomi~ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, ~~ma~e~~~y. K~-IVRSHIO ~}-~1VI~ D SN I~~}-~
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. - (Name) .
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~.Sworn' To and subscribed before me this ~ day of , 19 ~ 1r~
~
~ ROGER POITRAS
CLHtK CIRCUIT COURT Notary Public
By D.C. My Commission expires
(To b~ ~x~cut~d in duplicah and ori~inal fil~d wilb C1wlc ~uCUH Court, and e~plicsb with Tax Asse~r.)
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