HomeMy WebLinkAbout2963 Deciaration ot Domicile and Citizenship
TO TFIE STATE AND COUNTY TAX ASSFSSOR,
Sl. IUCIC COUNTY, FIORIDA ~~~0~
This is my declaration o( Domicile and Citizenshup in the State of Florida that 1 arn fil~ng this day in accordance and
~n conformity with Chapter 222, Section 2~2.17, Florida Statutes.
I was formerly a legal resident of _ - -
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~C~ty~ (State)
and I ~esided at _i~~!. _1 ~~j~.--~ 7---- - However I have changed my domiGile
(Street and Number)
to and am a~d have been a bona fide resident of the State of Florida since _ - 3 day of
a~/~+' 19
7~; and I reside at
~,~u- - ~-~s' ~ ~°'f_ 6~s `
~ (Sireet and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual lega! residence and domicile in the State of Fiorida.
(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.)
Applying; for Homestead ~
Entering children in school ;
.dc,e~~~ ~ ra~o ~NC? ~~cuK~~o
~T. ~ucie ;,ouNrr ~ ~
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I FURTHER CERTIFY that I will comply with all other requirements of a(egal resident of this State.
1 FURTHER CERTIFY that I have no intention to return to my former domic,ile, and I intend to remain in FORT
PiERCE, SAIN7 LUCIE COUNTY, FLORIDA, permanently. ;
,N~~~1111~~~~. ~
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: (Name) ;
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Sw~?~n to and subscribed before me this day of .-=t!`-e c/ , 19 7 Z: {
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ROGER POITRAS - -
~ CLERK CIRCU C URT Notar Public
~ IT O y
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~y _ ~ _ _ D.C. My Commissien expires -
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~ (To be executed in duplicate and original filed with Clark Circuit Court, and duplicate with Tax Assessor.)
~oox ~rJ P~CE2~
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