HomeMy WebLinkAbout0028 Dacls~ra~ion ot Damlci~e and Citlsenshi~ 1~iS3g
TO THE STATE ANO COUNTY TAX ASSESSOR,
51. ZUCIE COUNTY, FLdRIDA: I
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This is my deciarotio~ of Domicile and Citizenship in the State of Florida that I am fifinq this dey in sa~ordanos a~d
~n conformily with Chapts~ 222, Sectian 242.17, Florida Statutes. ~
I was f~merly a legal resident of Glenell,yg _ Illinois ~
(City) (Sts») ~
and 1 resided at 465 I.swell Ave u! . Howevar ! have chan~! my domidle
(Straet and Numbar)
ro and am and have been a bo~a fide resident of tha State of Florids since ~h day of
OCtober , t9 67, end 1 reside at 850 Airoso Blvd.
S (Stt~et and Number)
FORT PIE~CE, S/UidT LUCIE COUNTY, RORIDA ~
a~~d this statement is to be taken as my declaration of citiunship, actual legsl residencs snd domidle in the Stsro of Horida.
- (Insert here any pertinent facts, suth as sale of prcperty or buciness, or relinquishment of employment
at f~armer domicile, removal of family to new domicile, purchase of home, etc.) -
B~stablish Residency~ for homes~ead exe¦ption. ~
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~ RECpRDED' ~
Ft1.E~ AND NTY~ ~1.A• 1
" si. ~~~o ~ °vEa~~~ S E
~F c ~61~
~ pM 12 : 0 ~
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1 RJRTHER CHtTIFY tF~t I wil~-oomp)y with al! ~ther raquirements of a le~a) residsnt of this State.
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1 FURTHER CERTIFY that 1 have no intention to retum to my former domic~le, and i intend to remain in FORT ~
PiERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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(Name} Rus ell S. Suppiger ~
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, _ (Ac~dress) t
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-~Swoi.Y'fo ~d^~u~suibe~d before me this 7th day cf Novea~ber , 19 6? i
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RO~iER ~OI?RA3
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~i~jK"~I~CUIT COURT ~lotary Public
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~ - gy D.C. My ~:armission expires
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~ (To b~ ~ucvt~d ie duplicat~ an~ o~i~iea! Al~d witb Clwlc Ciraeif Cowf, and dupi~csh wHh Taac AaMS~.)
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