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Declaration ot Domicile and Citizenship 2~~18
TO TNE STATE AND COUNTY TAX ASSESSOR,
5~ . IUCIE COUNTY, FLORIDA:
This is my ciecla~ation of Uomicile and Citizensh~p in the Sta~e of Florida that I am filing this day in accordance and
~n conformity with Chapter 222, Scction 222.17, Florida Statutes.
1 was formerly a legal resideM of ----~!4'~ --~Bl~ -
(City) (State)
and 1 resided at __~Q~ ~(P___ S~ ![_d~.-SL~.-------- • However I have changed my domiC~le
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ____~__G__ day of
'T - s o ~ ~ ~~A ~.~i?~ v~
! _ _ 19_ , and I reside ~at
, Poh~- `s`~t ~ v
c~e ~ 3 ys`~ ~
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile i~ 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 fam+ly to new domicile, purchase of home, etc.)
/ - 238'718- .
A 1 ing? for Homestead
PP Y
=T.llplClE COUNT1fRfU. -
tIOCER F4tTRAs
CLERK Ct:;CUtT COUIIT
Establishing residence RECOR~ YE??FtEO~_.
S~r 2l 9 io AM'?1
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1 FURTHERaCERTIFY that I will comply with all other requirements of a legat resident of this State.
I FURTHER CERTIFY that I have no intenfion to return to my former domiCile, and I inte~d to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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,~.~~r$" "r'ri~jP a~nd subscribed before me this ~ day ofh~-~-t~~~ , 19~L ~
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- RO~~l.;:POITRAS -
RK ClRCUIT COURT Notary Public
. /ti~_~~~ ~ (G~ ~'{-f~-c~ ,
Qy _ _ D.C. My Commission expires
(To be executed in duplicate and original filed with Clerk Circuit Courf, and duplicate with Tax Assessor.)
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