HomeMy WebLinkAbout0690 ~
~eclaration ot Domtcile and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR, ~
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ST. IUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in aoo~rdanoe and
in oonformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of m~cheater Center Q@1"IDOnt
(~ity) (State)
and 1 resided at p'O.BOZ 252 , Flowever 1 have changed my domit}le
(St~eet and Number)
to and am and have been a bona fide resident of the Stste of Florida since lOth day of
A~ril , 19~_, and I ~eside at 149 Impetisl Way ~
(Street and Number)
FORT PIHtCE, SAINT LUCIE COUNTY, RORIDA ~ i
and this statement is to be taken as my declaration of citizenship, actual legai residence and domicile in the State of Horida.
(Insert here any pertinent facts, such as sale of property or business, or ~elinquishment of employment
st former domicile, removal of family to new domicile, purthase of home, ett.)
Establishing residence and applying for homeste~d
FILED ANO RECORDED
ST. LI,~CIE ~.OUtdTY. FLA.
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1882 ; ~7
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I FURTHER G~RTIFY that I wil) oomply with all other requirements of a leyal resident of this State.
~ I FURTHER CERTIFY that 1 have no intention to return to my former domicjle, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~ ::,r»r:?~».,, -
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~ ~ _ ~ (Na~Y1@)
~ - . _ ~ - _~'t~' ,3" Eussell geith
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' ' ~ -•f: } - (Address)
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~ ~ 13th January ~q ?0
~ Sworn to and subscribed before me this day of
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~ ROGER POITRAS
~ CIRCUR OURT Notary Public ;
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~ By ~~'e' `~~`'~'~v D.C. My Commiss'wn expires ~
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(To b~ uawt~d in duplicab and ori~ina! fil~d witb Cl~rk Cirwit Coue~, and duplieah with Tax Ass~or.)
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