HomeMy WebLinkAbout1225 . 1~4042
t~claratlon of Domicii~ ar~d Citis~nship
TO THE STATE AND COUNTY TAX ~wiSESSOR,
Sl. ltJC1E ~OtJNTY, fLORIDA:
This is my d~clantion of Domicils and Citiz~nship i~ th~ Staro of Flo~ida that 1 am filin~ this day in aooorda~a and
i~ aonf~amity with Chapt~? 222, Ssttion 2Z~.17, Florida Shtuhs.
1 wa: formarly a Ipal ~id~nf of T*'~*+te~ -$a_~-Tere°~-
(Ciry) (Stsh)
and t nsid.d et 8~ HerroQ Pleca . How.v.r ~ haw chanq.d my domidie
(Stn~t and Numbsr)
w and am and have been a bo~s fids rosident of the Stsro of Florida :inos -~..~th dsy of
j~~~embe~• ~~q_6A ~ an~ ~ ro~ide n_1,~6g„5 ~Seu -h Tndi an R~ver Drive ~Ld@n
(Strset and Numbsr)
!'ORT SAM1T LtIC1E COINrTY. RORIDA
and this statert~+t is b be taken as my dedaration of dtizenship, actual le~al res'~denoe a~d domidle in the State of Horida.
pnsert here any pertinent fads, such a: sale of propery or business, or relinquishment of employmsm
at formsr domidls, ~enwval of family to new domicile, purchase of home, Mc.)
Establieh residency for homestead purposes
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I RJRTI~it C'ERTIFY M~at i wlll oompiy with all othK roquinm~nb of a Ispal rosidsnt of this State.
1 FURTHER CERTiFY that I have no intention to retum to my former domitile, and 1 intend to remain in
i!!E~'E, SAINT UKfE COUNTY, fLORIDA, permanenNy.
~
Ma~)Waldan T. Petereon
~ Star Route Eden Jeneen Beach.Fle.
~
Sworn to a~d wbscribed befor~ mt this 21st ~y ~ Janue2~y , 19~~.
ROA~ tbtT~Af :
~ ~ Notary Publk
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~ ' _ D.C. My Commissior+ ~xpins
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