HomeMy WebLinkAbout1092 T ~
Dectaratiun ot Domicile and Citixenship
TO THE STATE AND COUNTY TAX ASSES~OR, ~~~~0
5~ . LUCIE COUNTY, FIORIDA:
TI?is is my decla~ation of Oomicile and Citizensiiip in the Siate of Florida tiiat 1 am fifing tiiis day in accord'ance and
in conformity with Chapter 222, Section ?22.17, Florida Statutes.
1 was formerly a legal resident of - -
(City) (Sfate)
and I resided at~~._~,.s However 1 have changed my domi~ile
(Street ar1c~ Number)
to and am and have been a bona fide resident of the State of Florida since ~ _ day of
19~~ and I reside at ...1 S
(Stre a~d 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.
(Inser~ 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.)
1\ '
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m . ~i~~ . /~p AND RECOROE!
~ fT LtlC1E COUMTY fu
~G~~~~~ ROCE~ POITRAS N
CLERK ClRCUIT COURT ~
RFCQRO vFR'F:EO...~.~.. ~
~ A~ 11 i2 os PM'?1
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1 FURTHER CERTiFY that I wilt comply with all other requirements of a lega) resident of this State.
1 FURTHER CERTIFY that I have no intention to ret~rn to my former domiCile, and 1 intend fo remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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- Sworn to ~ticf subscribed before me this day of , 19~
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I~-i,"•.. ROGER Q4ITRAS i
~ LtHtK'~IRCUIT GOURT Notary Public ~
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By e v? D.C. My Commission expires ~
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~ (To be executed in duplicate and original filed with Clerk Circuit Coutf, and duplicate wilh Tax Assessor.)
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„ ~°o K205 P~cF1092
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