HomeMy WebLinkAbout1330 Declaration of Domicile and Citizenship
TO THE STATE ANU COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FIORIDA:
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This is my declaration of Oomicile and Citizenship in the State of Florida that 1 am fil~ng this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
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I was formerly a legal ~esideM of ---~~1-~~--~J a"~ - '
(Ciry) ( te) ~
and I resided at _ J~"r_ y~ However I have changed my domiCile ?
(Street and Numbe~)
so and am and have been a bona fide resident of the State of Florida since ___~-"""L ~=s -/97 day of
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19~~, and I reside ~at _~ILI v ~.c. e~ , l~C~i~ c.T,l,~f,u..
(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 inthe State of Flo~ida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former dornicile, removal of family to new domicile, purchase of home, etc.)
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; Applying ~ for Homestead
Entering children in school :
F lE0 ANO iIECORp~~ -
~.tlfCiE COYNTY FIA. :
RQCER POITRAt
~ CtERk CIRCUIT COURT
RECORD YERlFIED
S~ 19 10 42 AH'1Z
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1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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= . ~ = (Name) .
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~~~"''~'Sworn to and subscribed before me this ~ y day o~" . . 19~Z'-
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OGER POITRAS
LERK CIR ~ COURT Notary Public
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p _ D.C. ' My Commission expires
(To be executed in duplicate and o~iginal filed with Clerk Circuit Court, and duplicate with Tax Assessor.)
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