HomeMy WebLinkAbout2782 ~eciaratlon ot Oomicile and Citizenship 1633U0 '
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E ~OUNTY, FtORi~A:
This is my declaration of Domicile and Citi=enship in the State of Florida that I am filing this day in sooordanos and
+n conform;ty with Chapter 2~?, Section 222.17, Florida Ststutes.
1 was formerly a legal resident of KipggtOil Penn
(City) (State)
and 1 resided at _ 54_ SOUth GppdW1Q Ave. ~ _ _~Wavei 1 have chanqsd my domi~ile
(St~eet and Number)
to and am and have been a bona fide resident of the State of Florida since lSth dsy of
ul ,~9 67 , and 1 reside at 160 Princess D i v
(Straet and Number)
FORT PiEitsE, SAINT LUCtE COUNTY, RORIDA
and this statement is to be taken as my declarotion of citizenship, attual legal retiden,e and domicile in fhe State of Horida.
(tnse~t he~e any pe~tinent fads, such as sale of property or busineu, or relinquishment of employmsnt
at fomner domicile, removal of family to new domicile, purthase of home, ett.)
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Establishing residence and applying for homestead -
ED ` ~
FIl.EO AND RECORO
ST.R
V~~RQ VERIFIEO~~
. 163300
'68 JAN 5 PM 2~
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.=or~?: :•~i ~ Ras
CLERK CIRCUIT COURT -
a
I RIRTHER CERTIFY that I will oomply with all other requiremenfs of a leqal ~esident of this State. ?
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~ 1 FURTHFR CERTIFY that 1 have no intention to return to my former domiGle, and I intend to remain in FORT `
i
~ PIERCE, SAINT LUCtE COUNTY, FLORiDA, permanently.
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f • ~~~.~i . CC.;'• ;
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_ ' _ _ ~ti' - (Name) ;
~ • . ° ~ I~ - .J. $artow - ;
~ n~ . . . ~ ~ ;
~ ~ (Address) '
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Sworn tv and subscribed before me this ~t~ day of Jan ~ 19 6$
ROGER ~OITRAS .
CiRCU1T COURT Notary Public
BY D.C. My Gommission expires
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E 1
(To b~ ~x~evhd in duplkat~ aed orioinal fil~d wilh ~IKIc pra+if Cduel, ~nd ~plieat~ with Tax Atws~or.)
g~169 ~2763 :
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