HomeMy WebLinkAbout1150Declaration of Domicile and Cltlsenship
TO THE STATE AND COUNTY TAX ASSESSOR,
ST. LUCiE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of Springfield
(City)
34 Daytona Street
and 1 resided at
(Street and Number)
Pass.
(State)
However I have changed my domicile
ro and am and have been a bona fide resident of the State of Florida since d enuary _ day of
lq~, and 1 reside at 114 Harris Street
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Jeremiah ldesaer
o pN° ~EN~ F p':
S L ~C~Ria VER~FI~EO
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this Stste.
1 FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
me) Geo ge F Hallenatein
Sworn to arir# supsaibed before me this ~ 8
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CI~CIJIT C T
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gy ~ D.C.
(Address)
day of January ,~q 69 ,
Notary Public
My Commission expires
(To ba executed in dupliuh and original filed with Cleric Circuit Court, and dupliuh with Tax Awessor.)!
a~K x.79 X1149
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