HomeMy WebLinkAbout0027 Decla~atl4n o! 09micile and Cltis~nship '~s~~~'
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?O THE STATE AND CUUNTY TAX ASSESSOR,
Sl. IUCIE ~OUNTY, Fl~R1~A:
This is my decla~ation of Domicile and Giti:enship i~ the State of Florida that 1 am filin~ thi: day in aocordana and ~
in tonformity with Ch~~ter 222, Section 222.17, FbTida Ststutes.
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I was fo~merly a legal resident of l~r+rtl~$r~,wic~k ~A?'80„----
(City) (Sfab)
and I ~esided at r.l,p... Le1'1o7c Anenuei llilltnwIl~ H. J. . Howsver I hevecharpsd my domidle
{Street and Number)
ro and am and have been a bona fi~e resident of the State of Florids since ~.8..~ day o~
---+j-u~ . 19~. and I mside at ~~A'~~ 9~r~t~tS»~mi t Str.sat
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FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement ii to be taken as my dadaration of citizenship, acfual le~al re:idenc~ and domicile in ths Steb of Horids.
(Insert here any pertinent facts, such as sale of property or lwsiness, or relir~quishment of employment
st former domicite, removal of famity to new doneicile, purchase of home, etc.)
Establiah reeidency for homestead e=e~ption
purpo$es. i
F~~F~ AND RECORDEps
ST. (,uCt~ COUNTY, F~~ ~
RECORD VEpIF1ED
16153~
. ~T Npy l ~y ~
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CLERK ~F
CIRCUIT COURT
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1 RJRTNER CERTIFY that I will aomply witfi all other requirements of a le~al rssidtnt of thls State.
1 FURTHER CERTIFY that 1 have no intention to retum to my former domic~le, and I intend to remain in FORT ;
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PIERCE, SAINT LUCIE GOUNTY, FLORIDA, permanently. '
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~~z~a~s~ '
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(Name~alteY' L. ~urp ;
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(Address)
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Sv~orit.~o and subsuibed before me this day of . 19-~-•
~ . ~QOER •lOITRAS ~ ~
~ - Ct~R1E:CIACUR COURT Notary Publit i
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gY. - D.C. My Commission expi~es ~
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Ro iM aaaarNd in dvpiieah an~ ori~ieal Rl~d with Cl~ek Cies~rit Caue~, and ~ wiM~ Tax A~or.) ~
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