HomeMy WebLinkAbout1291 Declaratton ot Domicile and Citize~ship
TO THE STATE AND COUNTY TAX ASSESSOR, ;
1
~i. Li~CiE COU~i~ ~ , Ft~Ri~1i: ;
TFiis is my declaration of Oomicile and Citizenship in the State of Floride that I am filing ihis day in accordante and
in conformity with Chapter 222, Section 22~.17, Florida Statutes.
I was formerly a legal resident of _ Penn
(City) (State)
and 1 resided at _~ZSUtllfvetA StTe@t However 1 have-changed my domicjle ~
(Sireet and Numbe~)
i
~su Jul 1 '
to and am and have been a bona fide resident of the State of Florida since ~ day of
- ;
I
, 19..(~~, and I reside at 1006 Mississippi Ave
(Street and Number)
fORT PIERCE, SAINT ~UCIE COUNTY, FLORIDA ~ ;
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida. i
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employme~t ~
at former domicile, removal of family to new domicile, purchase of home, etc.) ~
Filing for homestead exemption '
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~ 1 FURTHER CERTIFY that I will oomply witfi al) other requiremenSs of a legal 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.
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~ ( ame) 08. W. Y~1ldmsri
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~ (Address)
~ Swotn fo ~rtd subscribed before me this 23 day of J~ , 19 70 .
_ ~
: .
~ ROGER POITRAS
~ ~ CLERK CIRCUIT COURT Notary Public
~ By ' D.C. My Commission expires
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~ (To b~ executad in dupliut~ and oriyinal ~iled witb CIKk Grcuit Court, and duplicat~ with Tax As~ssor.)
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~ ~o „ soaK 182 PAGE 1289 ~
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