HomeMy WebLinkAbout1112 Oecla~atia~ of Domicile a~d Citizsnship ~62'~
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TO THE STATE AND CWNTY TAX ASSESSOR,
Sl. tUCIE COUNTY, FLORIOA:
This is my declarotion of Oomicile and Citizenship in the State of Florida that 1 am filing this day in aooordance and
in oonformity with Chapter 222, Section 222.1:, Florida Statutes.
pg pgR,g WISC.
1 was fo~merly a legal resider~t of -
(City) (Ststs)
903 ChiCigO St . _}b",~ever 1 have chanyad my domiti1e
and I ~esided at _ . ~
(Strset and Numbe~) ~
- 20th da of ~
to and am and have been a bona fide tesident of the State of Florida sinee Y ~
August . 1967 , and I roside at Rt. 2 Box 2T60 ~ SBBASTIAN RD. ,
(Street and Number) ~
~
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
a~d this statement is to be taken as my declarotion of citizenship, actual legal residencs and domicile in the State of Ho~ida.
(Insert here any pertinent facts, such as sale of propeny or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.) ~
FILING FOR HOMESTBAD PURP~6BS
_ ~
~ f ILED AND RECOROEO ~
ST, I.UC~E C vV aTF E
LA•
~c_COnn
~ ~ 11: OS
• DEC
61
~ 162~:26
~n ~ ~ o; ? R~s
CIERK CIRCVI? COURY
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1 FURTHER CERTIFY that I will comply wifh all other requirements of a Icyal resident of this State. t
. ~
I FURTHER CERTIFY that I have no intenfion to return to my er 'Gi~e, and t intend to remain in FORT }
:
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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~~iUliir~r:~ ~ , / ~
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: `t,,,~~,~~~.''~`~'••.,. ~
' ~.J ~N..:.~ (Name)
s ~ ~~'?J` : ROY . CLUMPNSR -
_ . n,~;. . ~1~ ~ .
:24~i=~~ ,~-~L.. _ - i
f' i't.•iv' : ~
• T• ~Te ~ Z.i' _ ~ ~-r ~
-;i. '•~.~a~.: ' = (Address)
,~.~1 »~t"~: ' Y~ i
.`e~.. e,~,~ ~
, G~;``.``
~'5~~~~p~1id subscribed before me this day of . 19 -
ROG~ r0
q~~ V pV~ Notary Public
~
gy .C. My ~ommission expires
(To b~ ~x~c~hd duplicsh and oriainal fil~d witb Cl~lc Gauit Couef, and dupliuh with Tax As~aor.) _
S~ i69 P~Eii~
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