HomeMy WebLinkAbout0009 Declaration ot Domicile and C~tize~ship
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TO THE STATE AND COUNTY TAX ASSESSOR, , ~ {
Sl. LUCIE COUNTY, FLORIDA:
This is my decla~ation of Oomicile and C;it~ze~sh~p in the ~tate of rionna that ~ am iiiing i~is doy in a~~dsnte and
in confo~mify witfi Chapter 222, Section 222.17, Florida Statutes.
i was formeriy a legai resident of HrOCYtOD ~838
(Ciy) (State)
Cal~nont Street
and 1 resided at _ _ However 1 have changed my domicjle
(St~eet and Number)
to a~d am a~d have been a bona fide resident of the State of Florida since ~li$l~_~ 1969 day of
_ , 19 , and I ~eside at 406 N. 22~1d Stteet _
(Street snd Number)
FORT PIERCE, SAINT LUCIE 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 pehinent facts, such as sale of property or busineu, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
~Filiag for ho'eatead eaemption
FILED AND RECORDED
ST. ~UCIE COUNTY, FI.A.
E?rCORf! VFR;~!ED..y
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'TO JAN 2 PM !2: 24
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pr;~ a ~n~TR:,S
i CLERK CIRCUIT C~URT
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I FURTHER ~ERTIFY that I will comply with all other requirementt of a legal reside~t of this State. ~
I FURTHER CERTIFY that I have no intention to return to my former domicjle, and 1 intend to remai~ in FORT
PIERCE, SAINT LUCIE jCOUNTY, FLORIDA, permanently. ~
~ ~ -~1~Caa
(Name) ~ Burni
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~ Swom to and subscribed before me this Zj1d day of Ji~uar9 , 1q 70,
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U~IT~C Notary Public
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~ By _ _ D.C. My Commission expires
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~ Qe ~•+~~ikvtid.i~t~dupliwM and ori~inal fil~d with Cl~rk qrcuit Cour~, and duplicat~ witb Tax Ats~sor.1
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