HomeMy WebLinkAbout0274 ~?eclttr~tion ~4 D~rtti+~jle ~nd 4;1tiz~n~hDp
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TO THF: STATE AND COUNTY YAX ASSESSOR, ~~,~~f,
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Sl. IUCIE COUNTY, FLORIDA:
Tliis is my declaration of Damicile ar.d Citizenship in the State of Florida that I bm filiny this day in accordance and
in conformity wifh Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of __~~sOII _ Ng1~ J82'80Y
(Ciiy) (Stete) ~ '
and I resided at 9~l5 ~baY ave.s_ Nowever 1 have changed my domiCile
(Street and Number) ,
to and am and have been a bona fide resident of the State of Florida since ___i5~____._ ~ay of ;
Allglls~-__ 19_6~_, and I reside at 14~_Al$8~_R~~[Sr~r„Rrk
(Street and Number) ^
FORT PIERCE, SAINT LUCiE ~OUNTY, FtORlDA
and this statement is to be taken as my declaration of citizenship, actual legal residencs and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of emptoyment
at former domicile, re~noval of family to new domicile, purchase of home, etc.)
~etabliahing residency
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FIt.,,~~ A~~~p RDED ~
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~ - ' ' - . ~ FtOGEF: :`i~f-; Ec;;~. CLERK ~
' . ~ : -ST. LUCIE COUNTY,
4 • • ~ FLORIDA
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I FURTHER CERTIFY that I will comply with all other requirements of a fegal resident of this State.
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~ 1 FURtHER CERTtFY fhat I have no intention to return to my former domi~ile, and ! intend to remain in FORT
j PIERCE, SAI~NT~,LUCIE COUNTY, FLORIDA, permanently.
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! . : : . - ' $eph ~~neyer
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Swom to and subscribed before me this 3~ day of J~a~' i9
,
; ROGER POITRAS _
'f RK CtRCUiT C URT Nolary Public
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~ D.C. My Commission exp~res
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i (To be execated in duplicate and vrigina~ fited with Clerk Circuit Court, and duplicate with Tax Assessor.)
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