HomeMy WebLinkAbout0695 Decl~ration o! Domicfl• a~d Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR,
51, lUC1E COUNTY, FIORIDA:
fihis is my declaration of Domicila and Citizenship in the Stats of Fla~.ia thst I am filin9 this day in aaoordenos and
in tonformiy with Chapter Z22, Section 222.17, Ftorida Statutes.
I was fo~merly a Isgal ~esident of ~indeAburst ~!M YOtt
(Ciy) (State)
~7 West Narine A~renue
and 1 resided at - . However I have chsngsc! my domWle
(Streat and Number)
ro and am and have been a bona fide resident of the State of Florida since July 1 ~y ~
, 19_~$, and 1 reside at 1021 Gstetrood Avenue
(Street snd Number)
fORT PIERCE, SAIN? LUCIE COUNTY, FLORIOA
s
and this statement is to be taken as my declaration of citizenship, actual legal residence a~d domicile in the State of Florida.
(Inse~t here any pertinent facts, such as sale of property or buainess, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
for hovestead purposes
RECQR~E~'
FILED AN ~~UNtY. FLA-
ST•RFrORp VERIftEO
1~5~55 : 09
'69 1~ 18 AN t 1
ROGE~ ;
O~T ~OURT~
~ CLERK CIRCUIT
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I FURTHER ~HtTIFY that 1 will aomply with all ofher requiremenri of a le~al resident of this State.
i FURTHER CERTIFY that I have no intention to retum to my former domicile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
- ~ Gr 4~_
~ tName) Caaill! ~1cRa!
'
. ' ' " C ~ . ;r' .
~ - • ` . ' ~ . (Address)
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Sv~~n.to~nd subxribed before me this 18 day of ~r~ , 19 69
. rL~i:
in. 'C
C~-
•...ROG~ POITRAS
CIERK CIRC IT COURT Notary Public
By D.C. My Commission expires
~To b~ ~x~cvf~d in duplicah and ori~inal fi{~d whb CIKk pradt Court, and duplieah with Tax A~sor.)
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