HomeMy WebLinkAbout0158 Oeciaration ot Oomicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
51. lUC1E COUNTY, FLORIOA:
This is my declaration of Domitile 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.
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I was formerly a legal res~denr of _West Ysven _ _ Conn. _
(C;y) (State)
and I resided at _ _ _ _ _ 2 ~ ~2 Ei1II S t . _ _ _ _ . However I have changed my domiti~e #
(Street and Number) ~
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to and am and have been a bona fide resident of the State of Florida since _ ~ st day of '
i
_ n^tc?.ber --l, 59. -a.~-~-~ss+d~ 1 1 1
(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 Horida. ~
(Insert here any pertinent facts, such as sale of propery or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
{Homestead Exemption)
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FILEO tiND RECORpEp ~
S:. LUCIE CQUr~?Y. F
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~ I FURTHER G'ERTIFY that I 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 forme~ domicjle, and I intend to remain in fORT
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PIERCE, SAINT LUCtE COUNTY, FLORIDA, permanently_ Je~IIlea A. C in -
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~ (Name) `
~ , _ . . ,
~ . 911 Cypress Ave.
" ' (Address)
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; ~ ~ .Sworn td.at~d subscribed before me this 5th day of Januarv , ~q_~0
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4t/!~~WiR P~~,R/~i
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~ CIRCUIT COUR Notary Public
~ By ~ D.C. My Commission expires
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~ (To be executed in dupliute and original ~s~ lerlc Circ ' rt, and dupliut~ with Tax Ass~ssor.) ~
s.
~ DOOK ~ PAG[ ~J 1 ~
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~ No. 13
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