HomeMy WebLinkAbout0930 Deciaration ot Dornicile a~d Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR,
~
ST, IUCIE COUNTY, FIORI~A:
Thi~ i: my dcclarotion of Oomicile and Gitizenship in ths State of Florida that 1 am fitinq thii day in aooordana ~nd
in cor~formity with Chapte~ 222, Sectio~ 222.17, Florida Statutes. ; '
1 was forme~ly a legal ~esident of I+aridY'u~1 SOUth CaY'OliriB
(Ciry) ' tStero)
~
and 1 ~esided at P• 0. BOY 638 - . However:t have thanqed my domitJle
(Street and Number) =
to and am and have been a bona fide resident of the State of Florida sinoe 15 th dsy of
November ,~9 69, anci I ~eside et 3400 Dale Place
(Street end Number)
FORT PIERCE, SAINT lUG1E COUNTY, RORIDA ,
and this statement is to be taken as my deciarotion of citizenship, actual legal residence and domicile in the Staro of Horida.
(Insert here any pertinent fads, such as sale of property or busineu, or relinquishment of employment
at former domicils, romoval of family to nsw domiale, purchass of home, etc.)
(Homestead Exemption)
. FILED AND REEA{ZDEO:
. ST. (.UCIE COUNTY, FLA.
RE:COR~ V= RIFIFO
~ - 18847'3 ~ ' ~
~ 'TQ JAN 19 AM 10: 06
i b~ i
~ ro~~r ~ ~~T~AS'~`~
~ CLERK CIRCUIT COURT;
~
_
~ I FURTHER CERTIFY that I will oomply with all other requirements of a le~al resident of this State.
1 FURTHER CfRTIFY that I have no intention to retum to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. grne~t Sylve ter
~
(Name
. :r,
~ ~ ` ~ 3400 Dale Place '
~ - ~ . ~ ; (Address)
~ . .
~ . .
~ - Sworn to:ariti-suburibed before me this 19th day of J821uaTV ,~9~Q.
~ ~ " -
~ f~>
' -
~ iti~0~~,~''OITRAS
~ CIRCUIT COU _ Notary Public
~
~ gy ~ D.C. My Gommission expires
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~ Ro b~ ~x~wtad In du icat~ a Al~d`"'~'~` Cirsvit Carh, aed du kat~ with Tax Au~s~orJ
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