HomeMy WebLinkAbout1189 Decl~~ation of Domicile and Citizenship
TO THE STATE ANO COUNTY TAX ASSESSOR, 238132
Si . lUC1E COUNTY, FLORIDA:
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This is my declaration oF Oomicile and Citi~enship in 1he Slate ot Florida that I am filing this day in accordance and
~n conformity with Chapter 222. Section 222.17, Florida Statutes.
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1 was formerty a (egal resident of _~~~(lI.I~/Z - ~ ~ - ~Q - - I
{City) (State) s
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and 1 ~esided at _ ~
T ~fY.S~~,~~~/! _ - - - Howeve~ i have changed my domiGile ~
(Street a~d Number) ;
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to and am and have been a bona fide resident of the State of Florida since __ti'""-~`---~-L.__~~_.-.-__ day of ~
. ~
_ . 19 and 1 reside at _(l~L~__...C ~ !
(St~eet and Number) ~
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FORT PlERCE, SAINT LUCIE COUNTY, FLORIDA ~
and this statement is to be taken as my decia~ation of citizenship, actual legal residence and domiciie in fhe Stafe of Florida. ~
(Insert here any pertinent facts, such as sale of property or business, or relinQuishment of employment ~
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at former domicile, removal of family to new domicile, purchase of home, eic.)
Applying j for Homestead ~
Entering children in school : ~
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I~ r~ ( r; ~,1 i(~ f LED Af~01tECOROED ~
- s~. ~uc~E cou~n f~~ ~ ,
. RpCER P011RAS
~ I ~f V r ~ ! ~ RECORO Y~a~FlEO C~RT ~
r. f~?h ~~b~~sG ~ 1!o ~ 18 8 s3 AH' t
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~ 1 FUR7HER CERTIFY that I will mmply with all other requirements of a lega) resident of this State.
~ I FURTHER CERTIFY that I have ~o intention to return to my former domic,ile, and I intend to remain in FORT
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~ PlERC~, SAINT IUCIE COUNTY, FLORIDA, permanently.
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~ ,',r•~~~~$Wb n to and subscribed before me this day of _ ,~q
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~ ROGFR POITRAS
~ CLERK CIRCUiT COURT Notary Public
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~ ~'Y D.C. My Commission expires
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~ (To be executed in duplicate and original filed with Clerk Circuit Court, and duplicate with Tax Assessor.)
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