HomeMy WebLinkAbout1406 Declaration ot Domicile and Citize~si~ip
,
TO THE STATE AND COUNTY TAX ASSES50R, 24~~00
Sl. IUCIE COUNTY, FLORIDA:
This is my declaratio~ of Domicile and Cit~ze~ship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes. ~
. ~
1 was formerly a legal resident of _~G~~~-~-_~ _ • - _
~ (City) (State)
~~O~Q~ ~ ~tA~" A~ {
ar~d 1 resided at ~ . However I have changed my domiCile ~
(St~eet and Numbe~) ~
i
to a~d am and have been a bona fide ~esident of the State of Florida since day of j
a- . ~ g~~~ '
, 19~ , and 1 reside ~at w~~ ~
~ (Street and Number) ;
FOR? 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.
(Insert here any pertinent facts, such as sale of property 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 :
~i.~ \ ` "l/ . 1
~ • ,
v - ~T.~UCtE COUNTYRlI~
~ ~ ~ IIOCER POnRAs
~~~L~ CtE1tK CIRCUIT COURT f ~
IlEC01lD VfRIilEO~
~CT Z~I ~0 0~ ~'I'~Z
~
' 24Q300 i
` , ~
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~ ~
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~ 1 fURTHER CERTIFY that I wil) comply with all other requirements of a legal resident of this State.
1 FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. - ~
, ~ ~ ~
:'~'t ,~;CO~~ r~: . 4
'f- _ 1~ ~ ~
~ ~ . - . ~ ' (Name)
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r c. - ~ ~ ~
~ `b "1 n ~ ~ _ - . . ~ ~ ~
~ ~ ' ~
~ ` . . . _ i` ' ~ (Address) -
~ _ . . . _ . ~G~ , . _ _ ~
~ Swor~ to and subsuibed before me this ~ day of ~ , 19 ~
~ ~ • ~
ROGER POtTRAS f
RK CIRCUIT COURT Notary Public
. ~
ey ~0~~'~ D.C. My Commission expires
(To be oxecuted in duplicate and oripinal filed with Clork Circuit Court, and dupliwte with Tax Assoswr.) ~
~ooK 207 PACF ~.4~
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