HomeMy WebLinkAbout0310 DeClaration of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FLORIDA:
This is my declaration of Oomicile and Citi:enship in the State of Florida that I am filing this day in accordante a~d
in conformity with Chapter 222, Section 222.'~7~fie~+da Statutes.
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.
Fall schurch Vir inia
I was formerly a legal resident of ~ -
(C;ty) (State)
and 1 resided at 309 Gt7poly DI. _ 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 _-__.2atb day of
Sept. ~q69 , and I reside at 1512 Citrus Ave~
- - u~ier~
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 ~elinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
(Homestead Bxemption)
FI~ED ~y0 RECOROED
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~~~C1F ~^UtvTY FL~.
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1 FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State. ~
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I FURTHER CERTIFY that I have no intention to return to my former domic.ile, and I intend to remain in FORT ~
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PIERCE, SAINT LUCIE COUNTY, FLORIDA, Perma~e~~~y. Wallace Texas Meadows ~
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MO o~~ 13,~x.[]1.A7./1A ~ 4
(Name) ~ -
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~ : " ~ . 1512 Citrus Ave. ~
~ • - : , (Address) ~
. ?th a f January 19 ?0 ~
: • Sworn- to~pnd subscnbed before me th~s d y o , ~
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~ . ROQLR ~ POITRAS ~
~ IRCUIT COURT Notary Public ~
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By D.C. My Commission expires ~
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(To be sxecuted in dupliute and originsl filad with Cl~rlc Grcuit Courf, and dupliuto with Tax As~es~or.) ~
BO K~O PACE
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