HomeMy WebLinkAbout0039 /
.
Declaration ot Domicile and Citize~ship
TO THE STATE AND COUNTY TAX ASSESSOR, ,
Sl. LUCIE ~OUNTY, FLORIDA: •
This is my declarotion of Oomicile and Citizenship in the State of Florida that 1 am filing this day in accordan:e and
in conformity with Chapter 222, Settion 222.17, Florida Statutes.
I was formerly a legal resident of ~'s.rggn j'nfn Indi~a
~C~ty~ (State3
and 1 ~esided at -_4~ PaYtOII Stte6t ~ ~ However 1 have changed my domiCile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since 1st day of
October , 19 68, a~ i reside a~ 614 Beach Avonue
(Street and Number)
FORT PIERCE, SAINT LUCIE GOUNTY, RORIOA
and this statement is to be taken as my declaration of citizenship, actual tegal residence and domicile in the State of Horida.
(Insert he~e any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to ~ew domicile, purchase of home, etc.)
Homestead Exemption
s
FIl.EO AND RECQRDED
; ST. LUCIc COUNTY. FLA.
: :~-.r~r;; y~??IFI~D
~
F i9a045
S
~ '70 FEB 18 A~4 !0: 58
~ a~Z-~
;;i~~;_"rt ~T~~.S
~ CL~RK ClRCUtT COURT'
~
~ I FURTHER CERTIFY tfnat I will compiy with a11 other requirements of a layal resiclent of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remaih in FORT
~ FIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~ ~
~
~
~ (Name) J ~ Fred Passwater
t
~ Ft. Pierce,Fla.
3 ~ - . 614 Beach Avenue
~i~::l i L~~'`
- ~ ~ ~ j , r,~ ~ (Address)
- V-'~St"~ Z.~`jri
~`-G'~, -
s ~ ~x,~~:• ~
} 18th February 70
~ ~r_ ~".ltnd subscribed before me this day of . 19 -
"R± r s _ f ~ l.
f• - • ~ .
' ' SG 4 ' ~v ~
:y~ ` % ~tOGF~~ ~OItRAs
~~CL~RK CiRCU1T COUR Notary Public
_ ~
gy D.C. My ~ommission expires
i'+KY
(To be ~xecvted in duplicate and ori~inal fila! witM Girk Circuit Cou~f, and duplicai~ with Tax A~sor.)
k;
^3 " 0 R
~~v Ne. ~3 BooK183 P~r~E 39
. . -
_ _
' _ ' - , ~ .