HomeMy WebLinkAbout0125 r' Decla~ation ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, ;
Sl. WCIE COUNTY, FLORIDA: ~
,
~
This is my declaration of ~omicile 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. ;
Batontown New ,]ersey
I was formerly a legal resident of - °
(City) (State) ~
~
However I have chan ed m domiti~e ~
and I resided at P~ U. BOX _ 14 _ - - - - 9 Y ~
(Street and Numbe~)
to and am and have been a bona fide resident of the State of Florida since _-19th day of
__~~t~-, 19
64, and 1-resids at _ _-CdE11Bd. Rt~ 2 Box 2596
- reet an um rr-
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.) '
~
(Homestead Exemption)
~
FI~ED AND RECORaED
; S i. LUCIE COUNTY. Fl.'A-
j :;-Cnrn ~
~ 1s ~
~ y • ;
~ '70 JAt~ 5 ~ ~Y. ~~'`~S
~
;
: n~[s s
CtE~?~ ~~RC~tj COURT
}
~
I 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 retur~ to my former domicjle, and I intend to remain in FORT ~
;
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_ ?
Dou ~ as Bell ;
~
ame) ~
~a;~; ~
, '
^ Eden Rd. Rt. 2 Box 2596 j
~ (Address)
Swom to bnd subscribed before me this Sth day of .J~ uarY ~ ~q 70 _
.
ROCEIt POITRAS
K CIRCUIT COURT Notary Public
' By ` ~ D.C. My Commission expires
~ (To bs executed in duplicaM and original filed with Clerk Ci~wit Court, and duplicats with Tsx Ass~ssor.)
~ eooKs~z
~~E ~25
LL~ r~.o. , a
:
, _ :
. : ~ ~