HomeMy WebLinkAbout0786 ~ i
: Df:ct~ir«~ic,~~~ ot t3c~micil:' a1[1!~ Citizc.•nslti~
lU TNE STAIC /1ND COUNTY T/1X /15SCSSOR, ,~W455
;1. IUCtE COUNI'Y, FLORtUA:
This is my declaralion of DomicilQ and Citizenship in the State of F!orida that 1 am filing this day i~ accordante and
in conformily with Chapter 222, Section 222.17, Florida Statutes. .
1 was forme~ly a legal resident of ~rn-~
(City) (S1a e)
and t resided at e~~ Howeve~ 1 have changed my domiCile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ~ day of
~ . ~ ~ -r/// ~ e C., ~f
_ 19 and 1 reside ~at ~
~ (Street and Number)
~ ~
FORT PIERCE, SAtNT LUCIE COUNTY, FLORIOA
and this statement is to be taken at rr~y declaration of cilizenship, actual legal ~esidence and domicile in the State of Florida. ~
(Insert here any pertinent facts~ such as sale of property or business, or relinquishment of employme~t
at former domicile, removal of family to new domicile, purchase of home, etc.)
Applyingj for Homestead ~ .
- Enterinq children in school :
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ORG Y p~ F~ ~~01?RT ~'f
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I FURTHER CERTIFY that 1 will comply with all other requirements of a tegal resident of this Sfafe.
I FURTHER CER7lFY ihat 1 have no intention to return to my former domiCile, and I intend to remain in FOR7
PIERCE, SAINT WC-1~~~OiJt~l7Y, FLOR(DA, permanentty. ~ -
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Sworn to and subscribed before me this day of , 19ly
ROGER POITRAS
CLERK CIRCUIT COURT Notary Public
,
~Y ~ D.C. My Commission expires
~R 786 ~
(To be oxecutod in duplicato and ori~inal filed with ork Circuit Cou~t, anJ ~duplicato with Tax Assossor.) ,
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