HomeMy WebLinkAbout2364 ~ ' • i
~ecl~r~lla~n af qt~mi~ile anc~ Cit~~enship - . ~
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TO THE STATE AND COUNTY TAX ASSESuOR,
~l. IUCIE COUNTY, fIQRIDA: - - • .
This is my deciarotion ~4` Uomicile and Cititenship in the State of Florida that i am filing this dey in accort~ance and
in canformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of ' ~ ~
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and i resided at~?` . However 1 have changad my domi~lle
~ (Streat and Number)
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to and am and have been a bc~na ftde ~esident of the State of Fiorida since day af ,
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~ ~ s+:~G~u~' ~ U ~ .
_ , 1~G2~~, and I reside at
• (Street ~nd Number)
FORT PiERCE, SAlNT tUClB COUNTY, FLORIDA '
~ end ihis statement is to be iaken as my declaration of cittzenship, octual legal reside~ce anc~ domicite in ihe St~ta qf Flortda,
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~ (I~sert here any pertinent facts, such as sale of property or business, or relinqutshment of employment
r, at former domicile, removal of famiiy to new domicile, purchase of home, etc.) -
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~i ~ ~ ~ . FI AND RECORDED .
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~ - - IN 600K ~'~~t {~R ~ -
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' ~ ~ : . ~ 196~ DEC 28 At~ 10: 07 ~ ~ . ~ ' ~ ` . .
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~ ROGER POITRAS. ClERK . r~e~~~
~ ST. llfClE COU4Ty, flORiOA ~ ~ ~ , + '
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~ i FURTHER CERTiFY that i will comply with al) otF~er requirerrtenta of a(egel resident of fhlt St~fe.
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~ 1 FURTHER CERTIFY that I have no intention to return to my former domi~ile, and i iMend to remaln tn FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. .
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s~ ~ ~ a? ~-•~S* • • ' (Name) .
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~~~~.v.~" ~ 4 '~I ~G~%r ~/~r . , ~
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~ ~ Swom to end subsc~ibed before ma thi: day of 19~~.
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~ $ ROGER rO1TRAS ~ ~
± K CtRCUlT C URT Notary PuWk ~
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= BY ~"~'~'C' a.C. My Commi:sion expires ~
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(To bf ~x~cvhd in du~licah and ori~inal filsd v~vitl+ qw~k Ciri+uit Court, at~d dvpliah with Tsx At~a
~ . BORK ~QU PAGE~~ci . _ .
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