HomeMy WebLinkAbout0622 i.
Decla~ation ot Don~icile and Cttizenshlp
.
TO THE STATE AND COUNTY TAX ASSESSOR,
5~. IU~IE GOUNN, FIORIDA:
This is my detlaration af Oomicile and ~itizenship in the State of Florida thst i am filin9 fhis day in saoordsrios at~d
in oonfo~miy with Chapter 222, Sectio~ 222.17, Florida Statutes.
I was formerly a legal ~esident of ~SSapec~tla ~ L. I. 11T@w YOrI[
(City) , (Stat~)
and I resided at 22 Ub10 Avenue . t~i~„rever I have changsd my domidle
(St~eet and Number)
to and am and have been a bona fide resident of the Stab of Florida since June 26 ~y ~
b8 2406 Me1Zan Court
_ , 19 , and 1 reside at ~
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNIY, RORIDA
and this statement is to be taken as my declaration of citize~ship, actual lega) residenoe and domicile in fhe Stats of Florid~.
(Insert here any pertinent facts, such as sale of property or busineu, or relinquishment of empioymant
at forme~ damicile, removal of family to new domicile, purthase of home, eic.)
homestead exemption purposes ,
~.FIL~EO hN0 RECQRDEO
5*.~•C~C{E COUNTY. FLA:
• -`~rrOR^u V~?!~I~C
l~ss~3
'69 f~f~R I 7 I~M I i: 3 y ,
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C~l-r;RK Eifi~UiT COURT ~
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~ 1 FURTHER CERTIFY that 1 will oomply with all other ~equirements of a legal resident of thi: State.
~ 1 FURTHER CERTIFY that I have no intention to return to my former domiCile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. - ~
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(Narr~e ard J. ox
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~G~~~y
~~i~erii'p
si~d;subsuibed before me this 17 day of MarCh ~q 69 ,
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'i; ~:~CKiEI~ I~TRAS
.:i =~~~tIRCU1T COURT Notary Public
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By ~ • D.C. My Gommiuion expires
•
(To b~ ~x~cvbd in duplicah snd ori~inal Rl~d with CIKIc qraiit Cour~, and duplieaN wilb Tax AtMaer.)
BOOK~~~ NAC~
No. 13
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