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Declaration of Domicile and Citizenahip
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TO Tm; STAn: AND COUNTY TAX ASSl!:SSOR,
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ST, LliCIE COUNTY. FLORIDA:
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This is my declaration of Domicile and Citiunshlp in ~e SfaCll, ~ 1.'I~ri~ ~ ;Ji ~ 1iling this day in accordance
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nnd in cunformity with Chapter 222, Section 22.2,17. Florida Statutes.
I was formerly a legal resident of
CAmp LeJeune
(City)
J.~o rth C .1' C 1 i. lin
State
:\nl I re~idp(1 at
324 Butler Drive
1Iowe\"er, I have changed my domicile
(Street and ~umber)
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day of
I" :1nll nnl and hu\"e been n b:lIla fide resident CJf the Stnte of Florida since
i1tigust
62
I:}_, and I re8ide Ilt
184 3elestio Court
Po rt .3t.. Luc 1e
FonT PIERCE, SAINT LUCIE COUNTY, FLORIDA,
(Steet and Number)
and thi~ stntpment is to be taken as my declaration of ,citilenship, actual legal re8idence and domicile in the St&te of Florida.
(In,ert here any pertinent facts, !ouch as sale of property or business, or relinquishment of employment
nt former domicile, removal of family to new domicle. purcha8e of home, etc.)
i1pplyin~ for ho~esteGd
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f." LL~ ..Il,ND RfCOnDED
" Off~al ROGOrd ' Jr,,];,
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ROGER PO/-.n,
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. UCIE cauwl ,'~ -l,r-
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I n:nTHER CERTIFY that I will register at m:; loeal addre8! when the registration books reopen, and comply
w:;h all ,ther rC<luirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend Ul rem..in in
FORT PIF-ReE, SAINT LUCIE COUNTY. FLORIDA, permanently,
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Carol J\nn ','il!on
- Harry F.
"ils.:..r.
';} 'r T " I (Name) .')"
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(Address)!
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dllyof
S\\'IJ] n : 0 ;1:1,1 :,ub~cribed before me this
~{oGER POITR..\ S
CLERK CIRCUIT COURT
Notary Public
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My Commill'lion expires
(Tn be executed In duplicate and Mlginal filed with Clerk Circuit Court, ""d dupllc.'ite with Tax A.sseM<I~)
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