HomeMy WebLinkAbout0807 D~ctaration ot Don~icil~ and Citi=~nship
1'73'747'
TO THE STATE AND GOUNTY TAX ASSESSOR,
Sl. U1CIE GOUNTY, FLORIDA:
This i: my detla~~tio~ of Oomitile and Gitisenship in the State of Flotida that 1 am filinq this day in aooordano~ ~nd
in conformlty with Chaptsr 22Z. Sectio~ 222.17,~ Horids Statutes.
1 wa: forme.ly a Ie~ai rosident of Hammonten ga~~*n~'+t0~a 1fT~w J~reey
(City) (Sts»)
and I restded at 2~1 ~[iddle Boad Howevar I haw d~srped my domicjl~
(Street and Number)
to a~d am and have been a bo~a fide rosident of the Stats of Florids sinoe lat. day oi
April ~~q66 , a~ ~ 619 willaw• Avanus
(5trset and Number)
lORT lIERC~, SAIN? LUC~ COUNTY, RORpA
a~d this staterr~ent is b be taksn as my dedaration of citizenship, act~al leyal residenos and domicile en the State of Horida.
(Insert he~e any pertinent facts, such as ssle of property or business, or relinqui~ment of emp{oymsnt
at tormer domicile, removal of family to new domiale, purchase of home, etc.)
Setablish
~a~ts~c~eeidence for Homestead purpoeee
FILEO AND R CQi~ 0 D' =
ST. I.UGI~ COU~TY~p~•
R~~~-!~~
'69 JA~ I 0 PM 2: Oq
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~ G POITRAS~
~ CLERK tRCUlT COURT'
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~ 1 RJRTF~R CHtTIFY that 1 wiii comply with all oti~ requirerr~snts of a(epal ~ldant of this State.
i FURTHER CERTIFY that I have ra intention ro retum to my former domitile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FtORIDA, permanently. :
(Name)
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(~?ddress)
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t.' y _ ' '~JJ
sworn to •nd wbscribsd b.i«• m. th+s 111-.`.__ day of s•„„ , :
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a ~.C. My Conunission ~xpi~ ~
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