HomeMy WebLinkAbout2824 ls~;~ ~
~eclaration ot Domicile a~d Cittse~ship
TO THE STATE AND ~OUNTY TAX ASSESSOR,
51. IUCIE ~OUNTY, FIORIDA:
This is my declaratio~ of Oomicile and Citizenship in ths State of Florida that 1 am filinq this day in acoord~no~ a~d
in conformity with Chapter 22?, Settion 2??.17, Florida Statutes.
~
,
1 was formerly a legal resident of Warren Ohio ~
tCity) (Stsh)
and I ~esided at _ ` 1376 N. ROa d N.B. Ho„revs~ 1 have chanqed my domicvle
J - (Street and Number) ;
to and am and have been a bona fide resident of the State of Florids since 23th day of !
i
_ No_v_erober , 19 67, and 1 reside at 410 S_ fl_ Gast~arilla
(Street and Number)
FORT PtERCE. SAINT LUClE COUNTY, FLORIDA pt. St~ Lucie
and this statement is to be taken as my declarotion ot citizenship, actuel legal residence and domicile in the State of Horida.
(Insert here any pcrtinent fatts, such as sale of property or business, or relinquishment of employment
st forme~ domicile, removal of family to new domicile, purchase of home, etc.)
estabilshing residence for hovestead exemplion
FILED AND RECOROEO~
ST. LUCIE COUNTY. FI.A.
RECORD'JERIFIED
163334 ~
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'66 JAN 8 PM//~~ I' 10 ~
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ciU:it'r', i~0i i R~S ~
CLERK CIRCUlT COURT
I FURTHER CERTtFY that I will oomply with all othe~ raquirements of a(e~al roaident of this State. ;
1 FURTHER CERTIFY that I have no intention to retum to my former clomi~ile, and 1 intend to remain in FORT
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PIERCE, SAINT LUCtE COUNTY, FLORIDA, permansntly. ~
"s
(Name) ;
;
Harold E. Casperson }
. _
- (Address) ~
''~wo~n to~a~.~ubscribed before me this 8tt? day of lanuary ,~q~g,
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= -
_ . itea~R' -
= ~ ~ . ~ Notary Public
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aY , , D.C. My Commission expires
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(To bs n d~pliuN and ori~inal fil~d wHh Cl~k CiraiN Court, ~nd duplicaN whh Tax A»~t~or.)
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