HomeMy WebLinkAbout1477 Declaration ot Oo~nicile and Citisenship
TO THE STATE AND tOUNTY TAX ASSESSOR, 1524'76
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Sl. LUCIE COUNTY, FLORIDA: `
1
This is my declaration of Oomicile a~d Citizenship in the State of Florida that 1 am filing this day in soo~rdance a~?d
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of OpalSka A1 a,..
(Ciy) (State)
and 1 resided at 1207 DensoD Drive . However 1 have chanyed my domicile
(Street and Number) • ~
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t~ and am and have been a bona fide ~esident of the State of floride since 13th day of
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May 66 4046 Greenwood Drive }
_ , 19 and 1 reslde at
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, fLORIDA _
and this statement is to be taken as my declaration of citizenship, attual legal residence and domicile in the State of Horids.
(Insert he~e any pertinent fads, such as aale of property or busineu, or relinqui:hment of employment ~
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at former domicile. ~emoval of family to new domicile, purchase of home, etc.) ~
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Applying for. homestead and establishing residence
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F~l„ED ANO RECORDE~ ;
ST. l.UC1E COUN'TY.1~~' ~
RECO~~~l~~
g pM 2 : 1 ~
'61 FEB
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I r~0~tr~ POITRAS
~ CLERK CIRCUI? COURT :
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1 FURTHER CERTIFY that I will oomply with all other requirements of a le~al resident of thia State.
1 FURTHER CERTIFY that 1 have no intention to retum to my former domicjle, and I intend to remain in FORT ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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,~ititi;urt:r;;~.; • i
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••,~~~•t ' CQ,;~~~i''3't,. i
j~., (Name) ~ ;
, - ~ Sam M. Hendrickson ~
~ _ ji~` i~:~ _
~ - _ ' : ~ ; (Address) 1
~ , . ~~y •.Y~~~.~~~
~ ~ , , 4 ~ ~
~ ~ r~'' ` 3rQ February ~q 67, ~
- - Sworn to and subsuibed before me this day of .
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ROGER POITRAS
CIRCUIT URT Notary Public i
a~~~ ~ ~
gy D.C. My Commission expires ;
(To b~ ~x~cut«! ie dupljut~ and ori~inal filed wiTh Cl~~ic prcuk Cour~, and dupliu» with Tax AsMSwr.)
s~K164 ~1475
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