HomeMy WebLinkAbout2413 Declaration ot Domicile and Citisensh~p
TO THE STATE AND COUNTY TAX ASSESSOR,
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ST. WCIE COUNTY. FI~RIDA: j
This is my declaration of Domitile and CitiZenship in the State of FlQrida that I em filinq thlt dey in acc~rdanoe and i
in conformity with Chapter 222, Sectio~ 222.17, Flo~ida Statutes. ;
I was formerly a legal resident of Lakeworth ~3orida _
(Ciy) (state)
a~d I resided at 2f>90 HBydeII DI'. . However I have changad my domiqtes ~i
(Streei and Number) ' ~
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to and am and have been a bona fide resident of the State of Florida since _ 17 th ~y ~ ~
OCtober ,~9 59, ar~ I reside at ~503 S. I21d. Riv. Dr. ~
(Street and Number)
FORT PIERCE, SAINT LUt1E COUNTY, RORIDA ~
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and this statement is to be taken as my declaration of citizenship, actual iegal residence a~d domicile in the Stafe of Horida.
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(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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(Homestead Exemption) ;
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FtLED AN~ R~COROED ~
~aT. WC:r 1Qt3PiTY^F! ~
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CL~RFC ClRCUtT COURT
1 FURTHER CERTIFY that I will comply with al) ofiher requiremen!s of a legal ~esid~nt of thia Stste.
I FURTHER CERTIFY that I have no intension to return to my former domicjle, and t intend to remain in FORZ f
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PIERCE, SAINT LUCIE COUNTY, FlORIDA, permanently. George ~lfl. k~~s~'l~E~' ~
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- (Name)
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~ ~ - ' 85G3 S. Ind. Rive.D
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, ~'`''~:tb:~ subsuibed before me this ~th day of FebrkarX , ~q?0 , '
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R COURT Notary Public ~
By D.C. My Commission expires
(To b~ ex~eut~d ie dupllut~ and ori~inal fil~d with C{~rk Clrcvit Court, and duplicat~ with Tax Ass~or.)
' earnc 182 P~c.~~~U~ ~
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