HomeMy WebLinkAbout1583 Declaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR. 238393 ~ `
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:i. LUCIE COUNTY, FIORIDA:
Tl~is is my declaration of Domicile and Citizenship in tlie State of Florida that 1 am filing this day in accordan;e and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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I was formerly a legal resident of
~~y) (State)
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and I resided at _ However 1 have changed my domiCile
(Street and Number) ~
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to and am and have been a bona fide resident of the State of Florida since j_ _~,day~
o~~
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- - - - 19~~, and 1 reside ~at~.~~t. ~ ~N~.~ ~Lr'2-~~~~~~!~.~.C (
(Street and Number) .
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA '
1
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in ihe State of Florida.
(Insert hsre any pertinent facts, such as sale of property or business, or relinquishment of employment
at forrrier domicile, removal of family to new domicile, purchase of home, etc.)
Applying ~ for Homestead ~
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Entering children in school :
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I FURTHER CERTIFY that I will comply with all other requirements of a lega) resident of this State. ;
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I FURTHER CERTIFY fhat 1 have no intention to return to my former domiu~e, and I intend.to remain in FORT ~
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PIERCE, SA~(uT~J~N~IE COUNTY, FLORIDA, permanently_ ~
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~ Sworn to and subscribed before me this ~ day of . , 19 ~Z
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~ ROGER POITRAS
' EP.K CIRCUIT COURT Notary Public
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~ E3y D.C. My Commission expires
~ (To be execuled in duplicate and original filed with Clerk Circuit Court, attd duplipte with Tax Assessor.)
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EO~K~rW F'ACE~S~O
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