HomeMy WebLinkAbout0894 Declaration ot Domicile and Citizenship 242168 ~
TO THE STATE AND C.OUNTY iAX ASSESSOR,
Sl. LUCIE COUNTY, FIORIDA:
This ~s my declaration of Domic~le and Citizenship in the Sta~e of Florida that I am fil~ng this day in accordance and
n conformity with Chapter 222, Section 222.17, Florida $tatutes.
I was formerly a iegal resident of _ ~,~4~"'~
(City) (State)
and 1 resided at ~~~x'«e~ However I have changed my domiCile
(Street and Number)
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ro and am and have been a bona fide resident of the State of Florida since , I~ . day of .
~ , 19_~l , and I reside at ~
(Street d Number)
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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.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at forme~ domicile, removal of family to new domicile, purchase of home, etc.)
.
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fILED~AhC RELOROEG
ST.lUC1E CJUNTY F~A.
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CIE~K r; ~u~; COURT
RE~ORC 4E~~FIfQ~i~~
NoY 16 li s4 AN'~1 -
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~ 1 FURTHER CERTIFY that I 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 former domiule, and I intend to remain in FORT
PI~RCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~ . ~ ` ~ . ~~a~~
~ . . (Name)
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~ • ~S o n to and subscribed before me this _ ~ ~ _ day of ~ ~ ~ , 19 ~ Y
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ROGER POITRAS
~fZlERK CIRCUIT COURT Notary Public
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~ By D.C. My Commission expires
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~ (To be executed in duplicate and original filed with Clerk Circuit Court, and duplicate with Tax Asseswr.)
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