HomeMy WebLinkAbout1623 Oeclaratio~ ot Don~icile and Citiz~nship ~~,~~4
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FLORI~A:
Thi: is my decle~ation of Domicile and Citizenship in th~ State of Florid: thst 1 am filinq this day i~ aooordano~ and
in confotmity with Chapter 222, Settion 222.17, Florida Statuhs.
So. llales Zaw York
I was formerly a leqal ros'ident of
(City) tStat~)
S. 6475 Olean , So. walee
and 1 ro:idsd at . Howwer ~ haw tha~psd my domkile
(Sneet and Numbsr)
~ Oct. 14
ro end am and have been a bona fide resident of the StaM of Florida sinae day of
, 19~.~, and 1 roside at 1112 So. ?th Street
(Strset and Number)
FORT NERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my dedaration of citizenship, sctual legal residenos and cbmkile in ths State of Horida.
pnse~t hers any pertinent fads, such as sale of property or buainess, or mlinquishmsnt of employmsnt
at former domicile, renwval of family to new domicile, purchase of home, etc.)
Purchaeed home
Intent of filing for homeetead e=emption
~t~-~~ AiVp RECORpEO
$T ~ ~~E COUNTY
c~na vfiR~F~EptA'
1'~~~4
~~8 5 ~ 1: 0 7
CLfi?~K ~ '~'Ot~:R~4S
~~RCUIT COURT
I
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I RJRTHER GEitTIFY that 1 w111 comply with all other requirerr~ants of a lepsl raident of thi~ State.
1 FURTHER CERTIFY that 1 have ra intention ro retum to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, fLORIDA, permanentiy.
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~ ~ ~ ~ (Name) ~auriC e ~ or
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- eneva a or
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_ ~ : ~ , (~lddress)
~=~1~ t
25th Aovember 68 i
' ~~S~tirqrn'~o Jsubsuibed before me this day of , 19 .
•...co.~,~.• -
ROGER ~ORRAt
CLERK CIRCUIT COURT Notary Public
8y D.C. My Commission expires ~
Re b. ~oac~rhd iA d~IkM. and ort~in.~ fi~d whb p.~lc c~kwif cowt, .nd dupuut. wiN~ Taac A~....era
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