HomeMy WebLinkAbout2306 • Deciaration ot Domicile and Citizenst~ip ;
TO THE STATE AND COUNTY TAX ASSESSOR, ;
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Sl. WCIE COUNTY, F~oR~oA: 263958 ~
This is my decla~ation of Domicile and Cit~zenship in the State of Flo~ida that 1 am iiling this day in accordance and
~n conformity with Chapter 222, Scction 222.17, Florida Statutes. .
1 was fomnerly a legal resident of •~~~d /~-~f~ /~J~a
(Ciy) (State)
~~~R ~m ~ . However 1 have chan ed m domiule
end I ~esided at _ g y
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~ (Street and Number~ • - _
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to and em and have been a bona fide resident of the State of Florida since ay of
- , 19152, and 1 reside ~at . ~ , L~ .
(Street and Numbe~)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this stateme~t is to be taken as my declaration of citizenship, actual legal residence and domicile in ihe State of Florida.
(Insert here any pertine~t facts. such as sale of properry or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Applying~ for Homestead .
- Entering children in schooi ; '
~ TN~ ~vE Y~ nI ~ - ~
F~~~01?NO RfCOROEfl
K /'7ic../~~ st tIOGE
CPOITRAS`A. ~ ~
. CLERK C1nCUIT COURT ~ t
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RECCR3 YERiFtE~ ~
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- - - - _ - ~iQ~ !4-~R -o ~ 18 2 5a PN'13
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~ 263958 ~
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~ 1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
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1 FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain i FORT
~,th~AN ~
PlERCE, SAINT LUCIE COUNTY, FIORIDA, permanently. ~ ~ ,
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~ o~tEra~d~~~~t~bed before me this ~ day of , 19~
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'''~r,......,....~ ' .
~ ROGER POITRAS
~ CLERK CIRCUIT COURT Noiary Public
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~ E3y D.C. My Commission cxpires
~ _ BcOK~~B PALE ~305~
~ (To be oxocuted in duplicate and ori~inal filed wilh Uerk Ci~cuit Couri, and duplicato with Tax Assessor.)
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