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Declaration of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FLORIDA: E
This is my declaration of ~omicile and Citizenship in the State of Florida that I am filing this day in attordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes. ~
I was forme~ly a legal resident of _ Det2'Oit _ M~Ch. _
~C;ty~ (State)
and 1 resided at ~45.~_ EVe2'gTee11 . However 1 have changed my domitile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ~ ~ th day of
AQVember , i9
62, and i reside at 835 Tierra Ct. Port St. I,ucie
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 Horida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at forme~ domicile, removal of tamily to new domicile, purchase of home, etc.)
(Homestead Exempt~~n;
ST~
V~ EN~ovECpRpEO'
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I FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that 1 have no intention to return to my former domicjle, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
Joe ~ ste
~ ~ P -
(Name
.r'." 835 Tierra Ct. Port St. Z
~ ~ ~ ~ ~ ~ (Address)
~ . . ' ' -
~ ' ~ ' Tannar
6wOfn'to-and subscribed before me this ~.f'.YL- day of ~ ~ , 19~2_.
~ ~
~ •
~ .
~ ~ ' ROGER ~OITRAS
~ tRCUIT COU T Notary Public
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~ gy D.C. My Commission expires
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(To bs exetuted in dupliute and original filed wiffi Uerk Circuit Courf, and duplicats with Tax Assessor.)
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~3 o R ~~2 ~35
BOOK PAGE
No. ! 3
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