HomeMy WebLinkAbout2178 Declaratio~ of Domicile and Citizenship ~4~902
TO THE STATE AND COUNIY TAX ASSESSOR,
Sl. lUC1E COUNTY, FLORIDA~
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
in conformity with Ct~apter 222, Section 222.17, Flo~ida Statutes.
I was formerly a lega) resident of _1S1 /~!?.m~'_!?-~7' - v)~ l i~ /~'i -
(City) ~ (State)
and 1 resided at _ '`~a-~ However 1 have changed my domiSile
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(Street and Number)
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ro and am and have been a bona fide resident of the State of Florida since day of
' 6 ~ _ ,9~_ ~~i~ ,~a~~i~ti
-~L' ? d - . . ~nd I reside at -
(Street and 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 ihe State of Florida.
(Insert here any pertinent facts, such as sale ef propsrty or business, or relinquishment of employment
at former domicile, ~emoval of family to new domicile, purchase of home, etc_)
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Applying ~ for Homestead n
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Entering children in school : 24Q902
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I FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my for.mer domi~ile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permar~4ntly_
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' Sworn fo arid "subscribed before me this -i_Ld day of v~~ , 19~.
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ROGER POITRAS
/CL,ERK CIRCUIT COURT No:ary Public , ~
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E~y D.C_ My Commission expires
(To be executed in duplicafe and origina) filec~, w~~ith Clerk Ci~cuit Court, and duplicate wiih Tax Assessor.)
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