HomeMy WebLinkAbout1156 -~~~;~1
Declaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
51. IUCIE COUNTY, FLORIDA:
This is my decla~ation of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapte~ 222, Section 222.17, Florida Statutes.
I was formerly a legal ~esident of _.__$a~~~r~l$~ ~Te• Jergev _
(City) (State)
and I resided at --_l~_ However 1 have changed my domiCile
(St~eet and Number)
to and am and have been a bona fide resident of the State of Florida since ___._~2#~- - - day of
_Qctobsr ~9
63_, and t reside at 103 8i~ge Plaae Fort PiereQ; Fla,._
. (Street and Number)
FORT PIERCE, SAINT LUi.IE COUNTY, FIORIDA - -
and this statement is to be taken as my declaration of citizenship, aduai legal residence and domicile in the State of Ftorida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Eatablish 8eeidenoy Sor homeetead ezemption
purpoeee.
i FILEO AND R N~Y DF A~•
' S7. LUCIE COtl
RECORD V--RIFIED
16412~ ; y
'68 FE8 ~
~
~ ~0~~~ t OtTRAS
= CLERK CIRCU17 ~OURT
1 FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
;
~ I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
- PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
. ~ ° ~~~ti~~~
- (Name) Ye~urfoe H. ~toG~'ath
(~lddress)
Sworn to and subscribed before me this ~tti+ day of February , 19~_.
- RO~ER'_ P~1'~RAS-'
~~CLEXK~CIRClZ1T COWtT Notary Public
~ ~ _
gy D.C. My Commission expires
J
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(To ~be; ~x~crced in dupliuts snd original filed with Clerk Grcuit Court, and duplicats with Tax Ass~ssor.)
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