HomeMy WebLinkAbout0463 ~ ~
Deciaration ot t~omiciie and Citisens~+j~ 1.S140S
TO TNE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
This is my detlaration of Oomicile and Citize~ship in the State of Florida that I am filing this day in acoordatxe and
~n co~formity with Chapter 222, Section 222.1T, Florida Statutes.
I was formerly a legal ~esident of p~'~A_~~A F~' -
(C~ry) (S:ate)
Rt . 3 BOx 1273G . However 1:~ave chahged my domicGle
and 1 resided at - - -
(Street and Number)
ro and am and have been a bona~fide ~esident of the State of Florida since _____.28th day of
December 66 420 N. E. Poplar Ave.
19-_, and 1 reside at
(Street and Number)
FORT PIEltCE, SAINT LUCIE COUNTY, RORI~A
and this statement is to be taken as my declaration of citizenship, actual legal resider.cc ~:w domicile in the State of Horida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employme~t
at former domicile, removal of family to new domicile, purchase of homc, e~c.)
FILING FOR HOMESTEAD PURP(~SES
51~~a
i
~ RENTM
ED
~ Ftt~~ AN~ F~,~?. ~
ST. LUCIE ~VEa1F1ED
; a~coao
~ ~ DEC 30 ~ 2 ~ ~l
z 66
~
~
~ R ppITRAS
~ ROvE ~JIT COUR?
~ I FURTHER CERTIFY that I will complyClei@~~IF~~r requirements of a legal resident of this State. ~
~ ~
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~ 1 FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~
~ ~ti~ ~ ~
~ (Name)
LAWRENCE E. GOL MITH ~ ~
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~ ' ~a • • ' ' ' - , 1966
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- ~-~worn td~¢ wbscribed before me this 30 day of Decembe~ ~
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~ E'1 ~~-CIRCUIT GOURT ~ Nc!t:; Public
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.ttit~:~
~ gy ~~-G ~-~~L~ D.C. My Commission expires
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(To b~ ~xscvt~d in dupliwb and o~pinal ~ilsd witb M::k Circuit CouM, and ~uplicat~ with Tax Ass~ssor.)
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