HomeMy WebLinkAbout1441 Declaration ot Domicile and Citisenship 1s4321
TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FLORIDA:
This is my declaration of Oomicile and Citizenship in the State of Florida that 1 am fili~g this day in attordance and
i~ co~formity with Chapter 222, Section 222.17, Florida Statutes.
~ was formerly a legal resident of ___T8mp8----- _~'"lOY'id8 _
(~~ty) (State)
and I resided a* _'~$Q~__]~~rtb, GOm@Z ~ However I have changed my domitile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since .________1Qt day of
_ ___~~BuS~.__-__-_, 19!6~_, and I reside at ___84$ ~l Rancho Drive
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citi=enship, actual legal residence and domicile in the State of Florida.
(Insert here any pe~tinent fads, such as sale of property or business, or relinquishment of employment
at fo~mer domicile, removal of family to new domicile, purchase of home, etc.)
Sold property in Tampa and wishes to
Eetablish Residency for homestead e=emption
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1 FURTHER CERTIFY that I will comply with al) other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domic.ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~ ~
(Name) wa d 1'. L311y
(Address)
SwQrn to and. subscribed before me this l~fih day of Februarv , ~q 68 .
- J .~W~ ~F'~1~'K
' J-,CLERiC GR~CnIT COURT Notary Public
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By~• D.C. My Commission expires
,
(To be executed in duplicaM snd originsl filed with Clerk Grcuit Cour~, snd duplicate with Tax Assasso~.)
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