HomeMy WebLinkAbout1092 Declaration ot Domicile and Citize~ship
TO THE STATE AND COUNTY TAX ASSESSOR, 242•303
Sl. lUC1E COUNTY, FIORI~A:
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This is my declaration of Dom;ale and Citizenship in the State of Florida that I am filing this day in accordance and
~n conformiry with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of ~ff~ - ~~-~k - . - ~ . -
~C~ty~ (State)
and I resided at _ ~~:/t --~~-,<Y-- -'~~~D----- However I have changed my domitile
(Street and Number) ~
to and am and have been a bona fide resideM of ihe State of Florida since v- _ _ day of
_ _ _ , 19_~~,. and I reside at _ _1~~'_.3 _ , _ - - .
(Street d Number)
FQRT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration ot 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.)
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IUCj~OpUM1Y F~A
ROCER Pp~tRAS
CLEftK C(RCWt ~
RE~4RD VFRIFFEO ~OURT
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1 FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
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I FURTHER CERTIFY that I fiave no intention to return to my former domic,ile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. }
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C~~~'.~, - (Name)
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~ ~ S~wAm~to ~and subscribed before me this ~ ~ day of
,
ROGER POITRAS -
CLERK CIRCUIT COURT Notary Public
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gy r .C. My Commission expires
(To be executed in duplicate snd originsl ~iled with Cierk Circuit Court, sed duplicats with Tax Assessor.)
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