HomeMy WebLinkAbout0295 Declaration ot Domicile and Citls~nshDp
TO THE STATE ANO COUNTY TAX ASSESSOR, j~~co~
vp
Sl. WCIE COUNTY, FLORIDA: , ~
This is my declaration of ~omicile a~d Cifise~ship in the State c+f Florida that 1 am filin~ this day in aooo~danoe and
in oonformity with Chapter 222, Section 22Z.17, Florida Statutes.
1 was fo?merly a legal resident of Newberq NeMi y4~~
tCity) (State)
and 1 resided at Rt 2 BQx ?81 Howevsr 1 have changed my domic3le
~ (Straet and Number)
ro and am and have been a bona fide resident of the Stste of Florids since ~ K;*+ day of
June , ti9_S~ and ~ ~eside at 71~ M?~.nd.Q~t Atte
(Sheet and Number)
FORT M~CE, 5111NT LIJCl6 COUNTY, ROR~A
and this statement is to be taken as my deciaration of atizenship, actual legal residence and domidle in tha State of Florida.
(Insert here a~y pertinent facts, such as sale of propery or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Bstablishing residence ~
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Appiqing for hon~estead RECORO yEp~~
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'6T ,1~ 951687'
AM 10 : 2~
AOGER Pp~TRAS~
CLERK CIRCUIT COURT
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~ I RJRTHER CERTIFY that 1 will oomply wHh all other requiremenis of a lepal resldent of this Stat~e.
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1 f(1R~I~R CERTIFlf that I have no intention to retum to my former domiG~e, and I intend to remain in FORT
. -rr _
PIERCE, ~AWV~~ COUNTY, FLORIDA, permanently.
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1; (Name)
- , ' , ,Q - - Frederick G, Prange . _ .
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Sworn to and subsaibed before me this _ day of .laDUa iy ~ 196?
ROGER POITRAS
CLiRK CI UR RT Notary Public
ey ` D.C. My Commiuion expires
(To b~ ~aarbd in snd orl~nal fit~d wilb Cl~ek G~i1 Couet, and dupliesb wiH~ Tax Ats~aor.)
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