HomeMy WebLinkAbout2772 Declaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, ;
Sl 141~1~ CQUNTY; FlnRIOA• ~
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in atoordante and
in conformity with Chapter 222, Sectio~ 22~.17, Florida Statutes.
I was formerly a legal resident of Chica~o I11.
(Ciry) (State)
and 1 resided at __~_~Q_ Burtori Pl . However 1 have changed my domiG~e ~
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since 8th day of
May 19
6~, and I reside at 617 Ash St . River Park
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
(Homestead Egemption)
FILED AND RECORDEO
~}T. LUCtE LOUr~TY, F~A. ~
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~ I FURTHER CERTIFY that I will oompl with all other r uirements of a I al resident of this State.
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. I FURTHER CERTIFY that I have ~o intention to return to my former domicjle, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLOR!DA, permanently. Z'Y E. I,Og f
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~sC,~~,~ _~~~~i,~,=, 617 lsh St. River Park
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~ _~a'','~' ~h;~ir`~i_'ia:an`~l~ui~uribed before me this 13th day of FebruarV ,~q 70,
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~ n~r CUIT COURT Notary Public
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~ By D.C. My Commission expires
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(To be execut~d in dupliute snd oripinsl ~ilsd with q~rk Circuit Courf, and dupliut~ wifh Tax Ass~ssor.)
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