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Oeclaration ot Dort~icile and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR,
ST. WCIE COUNTY. FLORIDA: ~
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This is my deciaration of Domicile and Citiienship in the State of Florida that I am filing this day in aooordante and
in oonformity with Chapte~ 222, Section 222.17, Florida Statutes. '
I was formerly a lega) resident of Cle~elaad 011~0
(City) (State)
1406 Sunset Road 1~yf ield Neights +
and 1 resided at - . However 1 have changad my domiCile E
(Street and Number) ~
b and am and have been a bo~a fide resident of the State of Florida since ~rch 26 day of ~
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, 19_~, and 1 reside at Route 2_ Be~c 2~56 ~ ~
(Street a Num
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FORT PIERCE, SAINT LUCIE COUNTY, RORIDA ~
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and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida. ;
(Insert he~e any pertinent facts, such as sale of property or business, or relinquishment of emp(oyment
at former domicile, removal of family to new domicile, purchase of home, etc.) ;
Filing for homestead exemption
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Fr~EO ANp r
ST. LU~~E RE~pRD~p~ '
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`0(/NTY,~LA;,_
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C~eRK c'RCUlT ~~~RT
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I RJRTHER CE~tTIFY that I will aomply with all other requirementt of a(egal resident of thia State.
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1 FURTHER CERTIFY that I have no intention to return to my former domiGle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. 1
,
(Name) ~wrence urgan
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Swom to and subsuibed before me this 12 day of Januar,jr ,~q~_.
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ROGER . NQITMAS ~
- CIRCWT COURT Notary Public
8y .C. My Commission expires
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"~~Rs'b~~~at~wt~d in dupltut~ and oripinal fil~d wiM~ Cbirk Circuit Couei, and duplicat~ wifh Ta~t Aswstor.)
A,~. „ aooK 1~~ PAGE 543
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