HomeMy WebLinkAbout0809 D~cla~atlon ot Domici~~ and Citisenship 1~3~?4g
TO THE STATE AND COUNTY TAX ASSESS4R,
.
Si. UJClE GOUNTY, fIORIDA: '
Thi: is my decls~ation of Oomicile and Citisenship in ths State of F~orida that 1 am filin~ thi• day in aaoordano~ ~nd
in conformity with Chspter 222, Ssction 222.17, Florid~ Statutes. .
i was former~y a ie~a1 ~sident of yor~r Psnna
(City) (Sta»)
and 1~id~d at ~ g~4 g Sherman Strsst my domidie
(Street and Number)
ro and am end have been a bona fide resident of ~ State of Florida sinoe 15 day of
Y83C , 19 68 , and I roside at 121 Eaa~ Arbor
. (Strset and Number)
1'ORT MERC~, SRINT tUC1E COUNTY, RORIDA
and thia :tatemsnt is ro be tsken as my declaration of citizenship, actuai legal residenoe and domidle in the Stats of Florida.
pnsert hero any pertinent facts, such as sale of property or busineas, or rolinqui~ment of employment
at fomns~ domkile, romoval of family to new domicile, purchase of home, etc.)
- i
EetajSliehing ~esidency for Homeetead purposes
" ~s:
FILEO AND RECORDED ~
ST."IUCIE COUNTY. FLA.
R~ C~~.}~~)~0
i es
.
~ '69 JAN 10 PM 2:Oq `
c'~-/ .
1ER OITRAS
~ CLERK C CUIT COURT
~
i
~
~ 1 FURTHER GgtTIFY that 1 will aomply witfi all other rec~uirements of a(e~al resideM of this State.
1 FURTHER CERTIFY that I have ra intention ro ~etum to my former domic~le, and 1 intend to remain in fORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
.
. (Name)
~
~
~
~ (~kldress)
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~ Sw~n ro and wbsaibsd before me this l~ day of ~~o»gr~? . 19 69.
ROfiiR rO1T~At '
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