HomeMy WebLinkAbout0604 Oe~laration of Domicil~ and Citisenship ~~r3~0 (
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TO THE STATE AND COUNTY TAX ASSESSOR, f
Sl, IUCIE COUNTY, FLORIDA: i
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This is my declsration of Domicile and Citizenship in the State of Florida that 1 am filirp thit day in aaoordanoe snd ~
in Qonformlfy wlth Chapter 222, SsNion 222.17, Fiorida Statutes.
I wss formerly a Ipal rosidant of Salem Indiana
(~iy) (Sta»)
U. S. Navy
and I rosidsd at . How~ver 1 have chanQed my domicjl~
(Street and Number)
b and am a~d have been a bo~s fide ~esident of the Stste of Florida sinoe AuRust 27 ~y
, 19 6? and I mside at 2712 South 27th Street
(~treet s~d Number)
l~ORT M~CE, SAINT LUCI~ COUNTY, RORIDA
and this statement is to be taken as my declaratio~ of citizenship, actual legal ~esidence and domicile in the State of Fbrida.
(insart hare any pe~tinent facts, such as sale of property or business, or relinquiahment of employrr~t
at former domicile, removsl of family to new domicile, purchase of home, etc.)
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Bstablisling residency for homestead exemption
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i FURTHER GfRTIFY that 1 will aomply witfi all other roquirema~h of a lepal resident of fhis State. -
1 FURTHER CERTIFY tFrat 1 have no intention to retum to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT i.UC1E COUNTY, FLORIDA, permanentiy.
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:f : ; _ (Name) David Lee Sullivan
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Sworii'to and subacribed before me this day of , 19 .
ROtiER ~OtTRAS
CLQIC COURT Notary Public~
By ~ D.C. My Commiuion expires
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iTe b~ ~a~Nd ~ dupikaN snd ori~i~al fiNd wilh CMelc qrarif Coue1, and drplkM~ wilh Tax As~orJ !
~ SooK 175 ~~vE 602 ~
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