HomeMy WebLinkAbout2227 . De:cl~~rati~~r~ ol t)otnicile ~-~c~d Citlz~nship
2514'76
10 111C STATE ~1ND COUNIY T/1X ASSCSSOR,
51. lUC1E COUNTY, FLORIDA: .
ihis is my dcclaralion of Domicile and Citizenship in the State of Flo~ida that 1 am (iling this day in accerdance and
in con(ormity with Chapter 222, Section 222.17, Florida Statutes.
rmerl a le al ~esident of ~~~-L~ Cy~C..
I was fo y g
(City) (State)
and I resided at 1~~ ~ Howeve~ 1 have changed my domiCile
~ (Street and Numb ~
. ~
to and am and have been a bona fide resident of the State of florida since 3~ day of
' . ~ 19.~, and I ~eside ~at ~a~ ~
(Street ~and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal resider?ce and domicile in the State of Flo~ida.
(Insert he~e any pertinent facts,.~such as sale of property or business, or relinquishment of employment
at former doniicile, removal of family to ~ew domicile, purchase of home, etc.) ~
~ 2514'~6.
Applying, for Homestead eEO ~p ~ -
~ ' R~
q~~~ -
- Entering children in school : - ~LERK Cr~~~n ~~R~
R~CQ~D VfA~FlED`,~i
. . ~ 6 ~ oo PN'T3
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I FURTHER CERTlFY 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 domiCile, and I intend to remain in FORT
PfERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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~SviibYli'fo and subscribed before me this ~ day of . 19L=•
ROGER POITRAS
CLE CIRCUIT COURT Notary Public
~ . ,
[iy D.C. My Commi,sion cxpires
(To be oxocutod in duplicato and ori~inal filed wi~~Cl~r Circuit Cowf, and duplicato wilh Tax Assossor.) . ,
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