HomeMy WebLinkAbout0593 • Declaration ot Domicile and Citizenship
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TO THE STATE AND COUNIY TAX ~1SSESSOR,
51. IUCIE COUNTY, FIQRIDA:
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This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and ?
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~n coniormity with Chapter 222, Section 222.17, Florida Statutes. ;
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I was formerly a legal resident of _ _
(Ciry) (State)
and I ~esided at / / •
-l~V~ -~~r
• • _ Nowever I have changed my domiCile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ___."2._~ _ day of
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- 19.~t.~_, and 1 reside ~at ~ 7 U ~ • ~
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FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my dcclaration 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 former domicile, removal of family to new domicile, purchase of home, etc.)
Applying f for Homestead ~ ~
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Entering children in school K~~s~s ~
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' I FURTHER CERTIFY that I witl compty with atl other requirements of a legal resident of this State. ~
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€ I FURTHER CERTIFY that 1 have no intention to return to my fornper domi~ile, and I intend to remain in FORT ~
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~ PIERCE, SAINT LUClE COUNTY, FLORlDA, permanently. • ;
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€ ~ - • (Name) ~
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(Address) ~
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i ~'SwarR ta a~d subscribed before me this ~ day of , ~q~
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' ROGER POITRAS
; RK CIRCUIT COURT Notary Public ~
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? gY - D.~. My Commission expires ~
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; (To be executed in duplicate and or+gina1 filed with Clerk Girsuit Covrt, and duplicate with Tax Assessor) #
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