HomeMy WebLinkAbout0239 Declaration ot Domicile a~d Citiaenship 1430~3~
TO THE STATE AND COUNTY TAX ASSESSOR,
51. IUCIE COUNTY, FLORIDA:
This is my declaratio~ of Domicile and Citizenship in the State of Florida that 1 am filing this day i~ acoordance and
in conformity with Chapte~ 222, Sectio~ ?22.17, Florida Statutes.
I was formerly a legal res~dent of Charleston West Viiglllia _
(City) (State)
q09 Mission Road
and 1 ~esided at However I have changed my domicGle
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _2.8.th_- day of
, 19_ 6~nd I reside at Rt 4 Box 295 X
(Street and Number)
FORT PIERCE, SAINT lUC1E COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pe~tinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Applyinf for homestead
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I FURTHER CERTIFY that I will oomply with all other requirements of a legal resident of this Stater. ~
1 FURTHER CERTIFY that I have no intention to return to my former domic.ile, and I i~tend to remain in FORT
PIERCE, SAIN7 WCIE COUNTY, FLORIDA, permanently.
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• - ~ Bverett Cart
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. ~ Grace Cart~~
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~5wbr~i~to and subscribed before me this 25th da of ~~q 66
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~ ROGER POITRAS
CIRCUIT COURT Notary Public
gy °t'`'~'G ~ D.C. My ~ommission expires
(To b~ ~x~cut~d in duplicsh and ori~ieal Rl~d will~ q~rk Gra~it Gourt, ae+d dupticat~ with Tax Assasor.)
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