HomeMy WebLinkAbout0571 Declaratio~ o! Do~»ic!!e and Citizenshi . 1 ~
p 63'~54 ;
TO THE STATE AND COUNTY TAX ASSESSOR,
Sj . lUC1E ~OUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Flo~ida that i em filing this day in acoordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of ~1t- V~rnpg Nt~r Ynr~
(City) (Stete) ~
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and I resided at ~ 4.Q ~uth 9th Ave,.nu~ _ . However 1 have changed my domiCile
(St~eet and Numbe~)
to and am and have been a bona fide resident of the State of Florida since 78th day of
`-~eceahet , 19~, and I re:ide at 11R Ba_ ~p.+
st Alde~,ti# ~
(Sfreet and Number) j
PORT PIERCE, SAINT lUC1E COUNTY, RORIOA !
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and this statement is to be taken as my declaration of citizenship, actual legal residence and domidle in the State of Horida. ~
(Insert here any pehinent farts, such as sale of properry or business, or relirx~uishment of employment
at fo~me~ domicile, removal of family to new domicile, purchase of home, etc.)
Establish Residency for Homestead Exemption
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NO RE~~~~F p• ~
~~~LU~~ aD o E~?F E~
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C`~RK CIRCU4T
I FURTHER CHtTIFY that 1 will aomply with all other requirementa of a le~al resident of this State.
I FURTHER CERTIFY that 1 have no intention to return to my former domic,ile, and I i~tend to remain in FORT
PIERCE, SAINT tUCIE COUNTY, FZORI~A, permanently.
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(Name) ~,s. Pat V. Laurrs
, (Pauline)
, . . (Address)
: . -
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Sworn to ancf s~ibscribed be{ore me this 2 3~.__ day of -~aauz~s' - , 19~g..
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CLERK Ct~CU1T COU Notary Public
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8Y D.C. My Commission expires
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(To b~ ~x~euhd in dupliu» and ori~i RI fil~d with CIKIc Cireuit Couef, snd dupli~af~ with 7ax Ass~or.) ~
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