HomeMy WebLinkAbout2428 Declaration ot Dor~ictfe and Citizensi~ip
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA: ~~941
This is my decla~ation of Domicile and Citizenship in the State of Florida tha~ 1 am filing this day in accordance and
in conformity wilh Chapter 222, Section 222.17, Florida Statutes. t~
. 1
i was formerly a legal resident of _ sd~ ~,.~~iidlSa i
~ (City) (State) `
and 1 ~esided at _~L~_S~. ~ L,dct~,~~ S~-t~feY' However 1 have changed my domicile
J (Street and Number) ~
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to and am and have been a bona fide resident of the State of Flarida since T~? • day of ~
;
--~~.~tL2~Y' , 19_l~, and I reside ~at ~ b~ T
- (Sfr et and Number)
FORT PIERCE, SAtNT LUCIE COUNTY, FtORIDA
~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sate of prope~ty or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Applying, for Homestead ~
- •~Entering children in school :
• Fll~O 4hp REOpR
~ ~T• IUCIE COUNTY ~i
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1~~ G.~? ~ el1~i SE ~!1 ~ ClE
K~C RC~It ~ S ~
- , , RECORO VERIfI
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. 238941
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I FUR7HER CERTIFY that 1 will comply with atl other requirements of a tegal resident af ihis State.
I FURTHER CERTIFY that t have no intention to return to my former domic.ile, and I intend to remain in FORT
PlERCE, SAiNT LUCIE COUNTY, FLORIDA, permanently. ~
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_ , J ~ ~~~.~~~G~ ~ (Name)
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Sworn-to and subscribed before me this day of L.~G'~l~c~~ , 19~~
ROGER POITRAS
RK CIRCUI? COURT Notary Public ~
L~".~- Li<.-u~`.~' .
dY D.C. My Commission expires
(To be oxecuted in duplicate and ori~inal filod with Clork Gircuit Court, and dupliwto wit6 Tax Assessor.)
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