HomeMy WebLinkAbout1248 Declaration ot Domicite and Citizenshi~ ~
TO T11E STATE AND COUNTY TAX ASSESSUR, 23SS61
Si . IUCiE COUNTY, FLORIpA:
This is my declaration of Domicile and C+tizenship in the State of Ftorida tha~ 1 am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of E_~~~J -
(City) (State)
and 1 resided at ~3_ ~~Y~'~!_~~___~_ However 1 have changed my domi~ile
(St~eet and Number)
, / 7 3
ro and am and have been a bona fide resident of the State of Florida since _!y~______~~- day of '
' -
- -7_~--__ 19~~, and I reside at ____LL1_~-_ -
~ (Street and Number)
FORT PIERCE, SAIN? LUCIE COUNTY, ELORIDA
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and this statement is to be taken as my cleclaration of citizenship, actual lega) residence and domicile in ihe State of Florida.
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(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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LuClf coUNTr flA.
ROCER ~O~TRAS
CIERK CI~;CUIT COURT C
' RECOR~ Vc1?~FtEO ~
. Auc T 1 12 03 PM '1 Z ;
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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 return to my former domi~ile, and I intend to remain in FORT ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. s
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r ' '•'y.j (Name)
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and subscribed before me this _ °2' 'Z- day of , 19~~ ;
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ROGER POITRAS #
GLERK CIRCUIT COURT Notary Public ~
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By _ C D.C. My Commission expires
- (To be execufed in duplicate and original filed with C{erk Circuit Court, and duplicate with Tax Assessor.)
BOUK (~lJ~ PACf ~2~0
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