HomeMy WebLinkAbout1775 Deciaration ot Domicile and Citizenship
TU THE STATE ANQ COUNTY lAX ASSESSOR, ~~r~~
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~i IUCIE COUNTY, FLORIpA:
This i; iny cledaration of Uomicilc and Citizensh~p in the State of Florida that I am fiting this day in accordance a~d
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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I was formerly a legal resident of ~'~7"-_'.'1~~y.C~~~_~ s-z-t c~~- -
(City) (Sfate) ~ ~
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and I resided at _ _ " _ . . However I 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 ~ day of ;
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- 19~~nd 1 reside at _10Gs •
(Street a 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_
(Inser~ here any pertinent facts, such as sale of property or busi~ess, or relinquishment of employment ,
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at former domicile, removal of family to new domicile, purchase of home, etc.) i
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Applying f for Homestead
Entering children fn school : ~ ~
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domiule, and I intend to remain in FORT '
~ PIERCE, SAINT LUCIE,GOUNTY, FLORIDA, permaneMly. ~
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Sworn to and subscribed before me this day of , 19_Zl/
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ROGER POITRAS _
CLE CIRCUIT COURT Notary Public
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~ ~3y _ r~. D.C. My Commissio~ expires
(To be executed in duplicate a~d original filed wifh Clerk Circuit Court, and duplicate with Tax Assessor.) ~
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