HomeMy WebLinkAbout0345 Declaration ot Domicile and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citize~ship in the State of Flo~ida that 1 am filing this day in accorda~ce and ;
in conformity with Chapte~ 222, Section 222.17, Florida Statutes.
Beaufort North Carolina
1 was formerly a legal resident of -
(City) (State)
813 Front St
and I resided at _ ' _ _ _ However I have changed my domicjle
(Street and Number)
to and am a~d have been a bona fide resident of the State of Florida since 28t~ day of
__~Y , 19
68 , and I reside at 11 R V i nda 1~ Ave. R t~---Z
Sireei and Number
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this stateme~t is to be taken as my declaration of citizenship, actual legal residence and domicile in ihe State of Horida.
(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)
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FILED AND RECOROEQ
ST. LUCIE COU'~TY, FL.'•.
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issoo8
7 Pt~ 2 : 12
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~ ~LF~-.~: C'?:l;!T COURT
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I FURTHER CERTIFY that I 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 domicule, and I intend to remain in FORT j
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. KeIIy rdon Lewis
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(Name) ~
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~ ` il~ Vindale Ave. Rt. 2 ,
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~ . ' ~ ~ (Address)
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. Sworn to,andFSUbsc~ibed before me this 7tb day of ~JBnUSiy ~ ~q 70 .
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: ~Of a.ER, ~OI~RAS `
~ GRGUIT COURT Notary Public
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~ By ~ D.C. My Commission expires ~
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~ (To be executed in dupliute snd original filed witb Clerk Circuit Court, and duplicate with Tax Assessot.)
~ R 1~2 ~~~E 343
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