HomeMy WebLinkAbout1093 De~la~at~on ot Domicile and Citisenship
TO THE STATE ANU COUNTY TAX ASSESSOR,
242304
51. lUC1E COUNTY, FlORIOA: .
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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I was formerly a legal resident of
~C~ty~ (State)
and I ~es~ded at _ 1~~0 _ ~„~C~%f_/'__~'?~~.~~''C~~' , However 1 have changed my domicjle
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ~ _ day of
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v 19_~l!and I reside at _ ! ~L _ ' " ~~=~-'~u~'~ -
~ (Sireet a 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 the State of Flo~ida.
(I~sert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removai of family to new domicile, purchase of home, etc.)
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~ 242304
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1 FURTHER CERTIFY that I will comply with all other reguirements of a legal resident of this State.
t FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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- _ -
U Ij _ - ' _ . (Name) .
~~''~`~;;;'~;''c~G'ti~;~~ arnes Chr~s+e~vse~/
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~ 'r••Saicom'to~~ subscribed before me this v day of ~v~~_ 19~
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~ ROGER POITRAS - -
~ C K CIRCUIT COt~RT Notary Public
/
By G~ D.C_ My Commission expires
(To be executed in duplicate and original filed with Clerlc Grcuit Court, and duplicate with Tax Assessor.)
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