HomeMy WebLinkAbout0216 Declaration ot Dornicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, •
51. LUCIE COUNTY, FIORIDA:
i
t
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in aocordance a~d ~
,
in conformity with Chapte~ 222, Section 222.17, Florida Statutes. ~
~
I was formerly a legal resident of -____Bethenp MO. !
(C~ty) (State) ~
~
~
1807 Be@km8D . However 1 have chan ed m domic.ile
and 1 ~esided at 9 Y
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _ NOV. 1 day o4 ~
69 137 Tunison Avenue (Port St Lucie) ~
, 19 and I reside at ~
- ~
_ - '
FORT PIERCE, SAINT LUCIE COlJNTY, fIORIDA
~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
tlnsert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new o~iciie, purchase of home, ett.) ~
Filing for homestead eaemption
;
~
i
FlI~ED ~R~D RECORDED
! L~ E U':-rv ~ , ~
, ~
t
~ ..Lg~i
I e?r) ~r~. ~ FLS~ ~~i •
~ I ~
E ~
~ . : _ : -~tl~'t•^_~;~~
i r~ r~~:! ~~~~~~:!'T~~,OURi F
~ ~
~ ~
f
1
I FURTHER CERTIFY that I wili cornply with all other requirements of a legal resident of thia State. ~
;
~
I FURTHER CERTIFY that I have no intention to return to my former domiu~e, and I intend to remain in FORT ~
1
a
PIER~E, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
? ~ ~ ~ {
f
( ame) Charlee Olin 9Phitten i
~ • t
~ ~c~ ~ .u~
F; ~
~ (Address)
~ ~
~
~
ra ~
~ Sworn to and subxribed before me this 6 ,day-of January ~ 19
~ ~ ~
~ ROGER POITRAS ~
~ CLERK CIRCUIT COURT Notary Public ;
~ 3
~ gy ~ D.C. My Commission expires ~
~ • _
~ (To bs executed in dupliwM and oripinal filed with Clerk Circuit Court, ~nd duplicat~ with Tax Ass~stor.)
.:f
Y
~ a~~1~2 f~~~ 215
~30. 13 . _
,
_ . ~
~ _ _ __:~;a;