HomeMy WebLinkAbout0156 Deciaration ot Domicile and Citizenship
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TU TIiE STA1 E AND COUNTY TAX ASSESSOR,
S i. IUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida tha~ t am filing 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 . _-._L~~
' (City) . te)
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and I resided at However I have changed my domiCile
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to and am and have been a bona fide resident of the State of Florida since day of
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_ _ 19~~, and I reside ~at ~ ~LU ' ~'t'~--
(Street a Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
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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 pertinent facts, such as sale of property or business, or relinquishment of employment ~
at forme~ domicile, removal of family to new domicile, purchase of home, etc.)
Applyingf for Homestead
Entering children in school :
FI~EOIIti;J ~~CvttOEo
~ ST. IUCt~ COItlITY FtA, i
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I FURTHER CERTIFY ihat I will comply with all other requirements of a lega) resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and 1 intend to remain in FORT
°IERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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Sworn to and subscribed before me this ~ day of , 19~.sz~,
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ROGER POITRAS _
CLERK CIRCUIT COURT Notary Public
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E3y ~ _ ~~t~ D.C. My Commission expires
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(To be execufed in duplicate and original filed with Clerk Circuit Court, and duplicate with Tax Assessor.) ~
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