HomeMy WebLinkAbout0515 Oecla~ation ot Domi~ile a~d Citise~ship
TO THE STATE AND COUNTY TAX ASSESSOR,
Si. IUCIE COUNTY, FLORIDA:
This is my declaration of Oomicile a~d Gitizenship in the State of Fiorida thst I am filirp this day in aooordenoe a~d
in conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of Summit New Jersey
- (City) (Stah)
and 1 resided at 10 ELiClid AverlLie . Hovwver I have changsd my domic~le
(Street and Number)
to and am and have bcen a bona fide resident of the State of Florida sinoe December 1 ~y ~
, 19 68, and 1 reside at 2801 Pocetello (St. I,uC3e Cour~t~cy
(Street a~d Number) Club
FORT MERCE, SAINT LtlCIE COUNTY, ftORIDA
anc! this statement is to be taken as my declaration of citizenship, actusl legal residenoe and domiale in the Staro of Florids.
(Insert here a~y perfinent facts, such as sale of property or busineu, or relinquishment of employment
st fomner domicile, removal of family to new domicile, purchase of home, etc.)
Establishing residency and homestead ezemption purposea
FI~ED AND RECOROED
ST. LUCIE COUNTY. FLd;
R~~~'~s~R:~~~o
.
'69 ~3~~ ! ~I AM 10 : 52 ` a„~
~ RO~~.R ?~OITRA 1
; CLERK CiRCUiT COURT
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I RJRTHER CERTIFY that I will oompiy with all ofher requiremsnts of a le~al resident of thit State.
I FURTHER CERTIFY that I have no intention to retum to my former domicjle, and I intend to remain in FORT
PIERCE, SAIIVT LUCIE COUNTY, FLORI~A, permanently.
'
• _ ~ - (Name) Haymond A. Caverl
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~;hR ' subsuibed before me thi: 14th day of , 1~9
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..4r~~~CIRCUR COURT Notary Public ~
By D.C. My Commission expiros
R~ b~ ~onaihd iw d~plica~..nd «ioiwal Al~d wilM G«# Ctew~it Cwr~, asd drpNcaN wilb Tac A~.rJ
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