HomeMy WebLinkAbout0928 • d~C~ilri :tinil U~ ~Ott11C{~~ ~illa.~ CIt12GfiS~lln ~
TO THE STATE AND COUNTY TAX ASSCSSUR, 250543
51. IUCIE COUNI~Y, FLORIDA:
This is my declaralion of DomicilQ and Citizenship in the Slatc of Florida that 1 am filing this day in accordante and
in confo~mity with Chapter 222, Section 222.17, florida Statutes. .
1 was formerly a legal resident of ' ~ S~D~(/~t~ D// _
~ (City) (State)
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and I resided a~i~q~ ' ~ . However 1 have changed my domic,iie
~ (Street and Number) •
to and am and have been a bona fide resident of the State of Florida since day of
~ , 19~ and I reside ~at ~ ~~~d . /r .~l/.S iZt~~('~ ~~q
(Street and Number)
:
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual lega) residence and domicil~, in the State of Florida.
(Insert here any pertinent facts,. such as sale of property or business, or relinquishment of emptoyme~t
at former domicile, removal of family to new domicile, purchase of home, etc.)
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1 FURTNER CERTIFY that 1 will comply with all other requirements of a(egal resident of this State.
! fURTHER CERTIFY that I have no intention to return to my former domicile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permane~tly. - ~~hl p ~ e°1
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~3worn5o.S?~~d•~eibstribed before me this !'l day of - ~1~~/fi-- , ~q~,
ROGER POITRAS
CLERK CIRCUIT COURT Notary Public
s
ay D.C. My Commission expires
(To be oxoculod an duplicate and ~ .na{ (iled with Cle~k CHc~it urt, and dupliato wilh Tax Assoswr.)
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