HomeMy WebLinkAbout2826 16?~t336 ,
O~cla~atio~ oi Don~icil~ a~d Ctttsensi~ip '
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TO THE STATE ANO COUNIY TAX ASSESSpR, `
51. lUC1E COUNTY, FLORIDA: 4
This is my declaratior~ of Dornicife and Citiza~ship in ths State of Flotida that I am filin~ this day in aooordanos and
in conformity with Chspte~ 222, Section 222. i 7, florids StetuMs.
1 was formerly a legal resident of ~llentiown pe~
(City) (StaM)
and I resided at ~ 270~j All@ri Str@et _ Hovrever 1 have charpsd my domitile
(Street and Number)
to and am and have been a bona fide tesident of the State of Florida since _6th dey of
_ _8ovember , ~q 6? , a~d i ~~~de at gt• Lucie Country Club
(Sheet and Number)
fORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this sfatement is to be taken as my cleclaration of citizenship, actual lagal residence and domicile in the State of Horida.
(Insert here any pe~ti~ent farts, such as sale of property or busineu, or relinquishment of employment
st farmer domicile, removal of family to new domicile, purchase of home, etc,) ;
;
Eatablisning residence and app~.ying for homeetead
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I FURTHER CERTIFY thst I will oomply with all other requirementa of a le~al resident of this State.
t FtIRTHER CERTIFY that I have no intention to return to my former domicjle, and ! intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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t'' , , . : (Name)
= ~ ~ , . = Dr. I,eo T. ~hylac~
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: . . . ~ ~ .
' - (Address)
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Sworn to and subscribed before me this 8th day of ~ J~u~Y jq 68
- ROGER rO1TRA5
. _ CIRCUR„~OURT Notary Public
B ~O D.C. My Commission expires
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(To b~ ~x~cut~d in dvplicaN and e~inal Rl~d whh Cl~ric Gnuif Cour1, and dupljcatr wilh Ta~c Assa~.) ~
8~K169 ~2807'
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