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~ . ' e t Do~nicfle ~nd Citize~shi ~ 4
Declaratio o P
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TO THE STATE AND COUNTY TAX ASSESSOR, ~ ~
ST. lUC1E.COUNTY, FLORIDA:
This i: my decl~ration of Domtdl~ a~d Citissnship !n ths St~te of florida th~t 1 am filinq this day tn aaoord~na ~nd
. in oonformily wlth Chapter 22Z, Section 222.17. Florid~ Stahit~s.
I wat fotmsrly a lepsl rosident of l~bM Jsrse~
" ~ (City) tSta»)
128~ Homss Parlc Aieaws. Ieelim _ i~~
and 1 ~ided st
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to and am and havs bee~ a bone fide ~esidsnt of ih~ Staro of Horida sinos ~3 day of
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: _~6~ t , 19
~~nd 1 rostde at 61T ~ B 8. 17t S~reet
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l~ORT lI~CE, SAtNT 1t1C1E COUNTY. ELORIDA ; .
: and thi: :tatsment is b bs taken a: my dedaration of dtizenship, sctual le~sl resids~oe and domkils in the State of Hortda. ~I
~ (Insen hero any pertinsnt facK. such a: ~le of property or busineu, or roiinqui:hn?snt of employms~t
, at former domtdle, ramoval of family to new domidle, purchase of homs, Mc.)
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811 tering ohil&ren in 5th arade. an+d Tl~b arads / R
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~ 1 FURTHHt CERTIFY that I will P~Y wi~
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~ all othsr requi~emsnts of a le~al rosident of this State.
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~ 1 FURTHER CERTIFY thst 1 have ~o intention to retum to my formsr domidle, a~d, l int~nd to rorr~in tn FORT
~ ~ ~ PIERG~,~S/lINT W~IE COUNTIf, FLORIDA, permsnently.
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~ e : ~ ' ~ - Helsa E. Sohrsi2ler ~
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~ . Swarn ro and wbsartbsd brf~or~ me fhi: day of 19
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~ Q~K WT COURT . Notary Pubik
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~ { ~ ' . D.C. My Go~wnluion expiros .
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~ ~ BGQK PAGE 4~ ~
~ Re b~ ~ iw d~pNue~ apd ~i~iw~l Nl~d whh Ciwk Cirail C«r~~, asd d~pNa~ whh Tax As~~ra
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