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Oeclaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, (
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Sl. LUCIE COUNTY, FLORIDA: ~
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This is my declaration of Domicile and Citizenship i~ the State of Florida that 1 am filing this day in accordance and i
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~n conformity with Chapter 222, Section 222.17, Florida Statutes. ~
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I was formerly a legat resident of __-?S~V~Z' Sprin~_____ ~ai ~
(City) (State)
Elderado Apts.
and 1 resided at _ However I havechanged my domitile
(St~eet and Number)
to and am and have been a bona fide resident of the State of Florida since _1$t day of ~
Apz`il 19
69_, and I reside at _ Rt. 2 BOx 2825
(Street and Number) !
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FORT PIERtE, SAINT LUCIE COUNTY, FLORIDA ~
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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 Floricia. F
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(Insert here any pertinent facts, such as sale of properry or business, or relinquishment of employment ~
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at former domicile, removal of family to new domicile, purchase of home, etc.) ~
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(Homestead Egemptiou)
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~FILEO ~N~ ~~~CORC~~
. l~-C1~ COUNTY, F '
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FEB 5 P~~ 3: 4y
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I FURTHER CERTIFY that I will mmply with al) other requirements of a legal resident of this StaTe.
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I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT '
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
Colin C. Levy ~
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Rt. 2 Boz 2825 f
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~ •Swo~1?,`tp apd subscribed before me this Sth day of Februarv ,~q2Q_. ~
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~OG~f~.~ r.PO1TRAS ~
~ ~ . ~'-,~t 41 ~ (tJIT COURT Notary Public :
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~ By ~ D.C. My Commission expires ~
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(To be executed in dupliuts and original ~iled with Clerlc Grcuit Court, and dupliute with Tax Assessoe.) ~
sooK~82 PacE2170 ~
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