HomeMy WebLinkAbout1253 Deciaration ot Domicile and Citize~ship
TO THE STATE AND COUNTY TAX ASSESSOR, ~~~s~
Sl. lUC1E COUNI'Y, FLORIDA:
This is my declaration oi Domicile and Citizenship in !he State of Florida that I ain fil;ng this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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I was formerly a legal resident of
(C~~y) (State)
;
and I resided at __.!J _~~~2_.._Lv. ~'~~,d1- However I~ave ch d my domiCite
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since __~.~s.-i~~---~ - day of ~
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----------~-1__-.-_-------. 19~~, and I reside at ~ ~J~
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA i
,
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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 pertineni facts, such as sale of property or busi~ess, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
FILEO ANQ RECORDEQ ~
St.LUC1E COUNTY fl~. ~
ROCE~ POI~RAS _
RECORO YEF.~f1E~ COUBT
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I FURTNER CERTIFY that 1 wifl comply with all other requ.irements of a legal resideni of this State. ~
1 FURTHER CERTIFY that I have no intention fo return to my former domiCile, and I intend to remain in FORT
PfERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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Sworn'to and subscribed before me this day of , 19~ ;
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ROGER POITRAS ;
CLERK CIRCUIT COURT Notary Public '
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By O.C. My Commission expires -
~ (To be executed in duplicate and original filed with Clerk Circuit Courf, and duplicate with Tax Asseswr.)
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