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Declaration of ~omicile and Cittzenship !
TO THE STATE AND COUNTY TAX AS~aSOR,
:il. LUCIE COUNTY, FLORIDA: ~
,
This is my declarotion of Domicile and Citizenship i~ the State of Florida that 1 am filing this day in actordanoe and ~
in conformity with Chapter 222, Section 222.17, Flo~ide Statutes.
I was formerly a fegal resident of Jensen Beach _ Plorida
(CitY) (State)
and I resided at _ 318 3td Sti!@t _ . However 1 heve changed my domicjle
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ata~= day of
_ ,~9
69_, and I ~eside ar 230 Aldea (River parY)
(Sireet and Numt~)
FORT PIERCE, SAINT LUCIE COUNTY, FIORIDA s
and this statement is to be taken as my dectaration of citizenship, actual legal residence and domicile in the State of Horida. {
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(Insert here any pertinent fatts, such as sale of property or busir~ess, or re~inquishment of employment i
at former domicile, removal of family to new domicile, purchase of home, etc.)
Piling for homestead exemption
FIL~E•0 AN~? rZECORDED
S~: CUCiE CGUtiTY. F! ;
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1 FURTHER CEftTIFY that ! wil) oomply with al) other requirement= of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
` ~ (.`~~~~/.~'7~R`
~ (Name) ~z U~ G. Fotdhav
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; (Address)
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Sworn to and subscribed before me thi; 9 day of JaDUSty? ~ 19 70
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~ . - CIRCW'~ COURT Notary Public
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~ $~y~ • ~ I D.C. My Commission expires f
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~ ;°Ra:bi`.~dM+d in dupliub snd ori~inal Rl~d with Cl~rk Grwn Court, a~! dupllcah witi~ Tax Ass~swr.)
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