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Declaratio~ of Domicile and Citizenship !
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TO THE STATE AND COUNTY TAX ASSESSOR. 143302 '
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Sl. lUC1E COUNTY, FLORIDA: ~ ,
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day i~ accordance a~cl
in conformity with Chapter 222, Section 222.17, Flo~ida Statutes. i
1 was formerly a legal resident of ___gfl~_ YO~_C~~ _ ~e~ YOr~ -
(City) (State)
and I resided at 174 pinewOOd a08Q _ However 1 have changed my domiti~e
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _~H~__~_______-_ day of
_ au~uat___ ,~q6~ , and 1 reside ar 7T5 Sola~ O~e. Port 3t.Zucie
(Street and Number)
fORY PIERCE, SAINT LUCIE COUNTY, RORID/~?
and thiz statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here any pertinent facts, such as sale of property or business, or ~elinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
~pplyina ior homest~ad
~ ~~9~~ROED
, ~ FI~ ROOK
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E - ' = 14330`~
~ - . . ` ROGEt~: . C~Ei~K
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~ • ' :r~ ST. lUC1E COU~: i Y.
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~ ~ FLORID~
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domic4~e, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ ; :j S I. n`7~'.•~i _ ~ ~ V,i/~1f ~f~YL/ i
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~ ; _ Otto Plang~aaa (
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~ ~'`f~'~~~~8ii~~n to and subscribed before me this 4th day of ~r~ , 19~~.
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~ ROGER POITRAS
K CIRCUIT OURT Notary Public
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6y D.C. My ~ommission expires
~ (To b~ ~x~cut~d in dupliuf~ and oripinal Rled whh Clerk Cirwit Court, and duplicat~ with Tax Ass~or.)
~ aooK139 544
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