HomeMy WebLinkAbout2383Declaration of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
St. IUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in aoDOrdance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of
Dasien
Connecticut
(Sts»)
(City)
and 1 resided at ~r17 OaY~ Park Avenue However I have changed my domicile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since Jyiy ~ l day of
19 6~, and I reside at 4411 Sunrise BlYd.
(Street and Number)
FORT r1ERCE, SAINT tUC1E COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile~in the State of Horida.
(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.)
Filing for residency to establish-grounds for hosestead
exemption and beco>Iling a resident.
-~1LED ANO RECOROEO!-
ST.IL-CORD VERTU EFIa.
~-,~~
'69 SEP I 0 AM 10 ~ 25
182818
ROt;~R r01TRAS -
CtERK CIRCUIT COURT;
1 FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
I 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.
V 'w"~ '
(Name) ~~~~~ WAD. Mayers
(.Aadtlren0 Rach N. Dlayers
.4 ~ ,
' •• •~..$wquifto,and wbsuibed before me this 10 day of Septe>aber fq 69
.r ~. i ;~D~ -OITRAS
.'• ,~.:~~ Notary Public
- "`; ,EI(tCU1T COURT
By'~• ~ D.C. My Commission expires
1
Re f:e executed in duplisate and original filed with Cleric Cirarit Court, and duplicate with Tax Armor.)
~. ,~
4`-.
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