HomeMy WebLinkAbout0572 ~ ~ ~
De~laration ot Domicile and Citizenship ~
TO THE STATE AND COUNTY TAX ASSESSOlt, •
23'7659
Sl. LUCIE COUNTY, FLORIDA~
This is my declaration of Uomicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
in conformity with Chapter ?22, Section 222.17, Florida Statutes. ~
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I was formerly a legal resident of ~ -
tC'ry~ _ (State)
C~`-`'c~ ~ H wever 1 have chan ed m domiCile
and I resided at - 0 9 Y
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since day of
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% - 19~~, and 1 reside ~at
~ (Street and 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.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment ot employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Applying j for Homestead _
Entering children in school :
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' CtERK Ct-~~jTR~S ~ `
' • flECORD YEP.tF~F~ COUA1 h~ C ~
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' 8 10 41 ~I'71
~ 23'~~59
I FURTHER CERTIFY that 1 will comply with all other requirements of a lega) resident of this State.
I FURTHER CERTIFY that 1 have no intention to return to my former domic,ile, and I intend to remain in F~RT
~p~~l~ d, ~c..-ber~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ (Name)
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~ Swor?S to and subscribed before me this ~ day of . 19~
ROGER POITRAS -
CLERK CIRCUIT COURT Notary Public
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gy D.C. My Commission expires
- (To be exccuted in duplicate and original filed with Clerk Circuit Court, and dupliwte with Tax Asscssor.)
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