HomeMy WebLinkAbout0178 Declaration ot Domicile and Citizenship ~
TO THE STATE AND COUNTY TAX ASSESSOR, 143~~ L
Sl. lUC1E COUNTY, FLORIOA:
This is my declaration of Domicile and Citizensh;p in the State of Florida that 1 am filing this day in acaordanos a~d
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal ~esidenr of - Sherman _ Tea~
~~~ty~ (State)
Rt. 1. . However I have chan m domitile
and 1 resided at - ~ Y
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since - _1St day of
- Nov. 66 2506 3.Acorne Ave.
, 19 and I ~eside at
(Street and Numb~)
fORT PIERCE, SAINT LUCIE COUNTY, RORIOA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domitile in the State of Florida.
(Inse~t here any pertine~t fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Piling for Hosestead purposes
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~ ~ ROG~ri ~ RaS. i,l.ERK
~T. LUCIE COUyTY.
FLORIOA
Yy .
1 RIRTHER CHtTlFY that I will oomply with all other requirements of a lega) resident of this State.
I FURTHER CERTIFY that 1 have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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V~~ C~ (Name)
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' ~ti 24th Februarq 66
U;; '~lbosq?tb,~ind subsuibed before me this day of , 19 •
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ROOER
CLERK CIRC OURT Notary Public
By ` D.C. My Commission expires
(To b~ ~x~wt~d in duplicat~ and ori~inal fi!«! with qNlc UrarN Court, and dvplicat~ with Tax Ast~or.)
a4oK 139 ~ `75
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