HomeMy WebLinkAbout0178 ' ~
. DeClaration ot Domicile and Citizensltip
268'791
TO THE STATE AND COUNTY T/1X ASSESSOR,
Sl. lUC1E COUNI'Y, FLORI~A:
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This is my declaration of Domicile and Gitizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes. ;
I was formerl a le al resident of ~ . ~ .
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(C~ty) (State)
and 1 resided at °2 O~'~ . Howeve~ I have cha~ged my clomiCife
~ (Street and Number) ~
to and am and have been a bona fide resident of the State of Florida since day of
_ ~ , 191~L, and I reside ~at . ~
(Street and Number) -
FORT PIERCE, SAINT LUCIE COUNTY, FLQRIDA
and this statement is to be taken as my declaration of citizenship, act~al legal residence and domicile in the State of Florida.
(lnsert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Applying~ for Homestead " ~ . ~
268'791
- Entering children in school : FIlEO AND RECOROEO
ST. lUC1E COUM7Y FtA.
~ ROGE~ POITRAS •
CLERK C:~CUIT COURT
• RECQRD VEktFIEO.~.r~
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. Nou ZO 9 55 AH'13 `
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~ I FURTHER CERTIFY that 1 will comply with all other requiremenis of a legal ~esident of this State.
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~ I FURTHER CERTIFY fhat ! have no intention to return to my former domicile, and 1 intend to remain in FORT
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~ PIERCE, SAINT LUGE COUNTY, FLORIDA, permanently. '
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; Sworn to and subscribed before me this ~ day of ~~"t"~~ , 19~3 £
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ROGER POITRAS
- ERK CIRCUIT COURT Notery Public ~
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~ Qy _ D.C. My Commission cxpires
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- (To bo oxQCUtecl in duplicaie and ori~inal filed ~w~h~C~erk Circuit Co~rt, and duplicato with Yax Assessor.)
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