HomeMy WebLinkAbout1253 Declaration of Domicile and Cjtizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
51, IUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the Stasa of Floride that I am filing this day in a~da~oe and
~n conformity with Chapte~ 222, Sectio~ 222.17, Florida Statutes.
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I was formeriy a leqal ~esident of flnll~ Ftnrida
(City) (State~
and 1 resided at - 9$30 ~I~.igjLSt*'p~t . However ! have thanged my ciomicjie
(Street and Number)
ro and am and.have been a bona fide resident of the State of Florida since October day af
69 Route 4 Boz 715A ~
, 19 , and I ~eside at r
(Street and Number)
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FORT PIERCE, SAIN? LUCIE COUNTY, fIORIDA :
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and this statement is to be taken as my declarotion of citizenship, actua! lega! residence and domicile in the State of Horida. ~
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(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employme~t ;
at fo~mer domicile, removal of family to new domicile, purchase of home, etc.)
: Filing for baqestead exemption
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F1LED ~=~dD RECORaED s
~,-r ~ t+yl~ r~Ut~''Y, rL:.. ;
~ ~ ~9t~$Si `
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I FURTHER GERTIFY that 1 will oomply with all other requiremenis of a legal'resident of this State. '
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I FURTHER CERTIFY that I have no intention to return to my former domic~le, and I intend to remain in FORT -
PiERCE, SAiNT tUCtE COUNTY, FLORIDA, permanentfy.
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(Name) John R Waller
(Address)
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, Sworn:to~;bnd suburibed before me this Ath day of ~gr~ , 19~2.
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ROGER,: Bd~AS - ~
CIERI~:tIitC!!1~` ~URT Notary Public
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By . , D.C. My Gommission expires ;
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(To be ozecuted in duplicate and origina! Fled witb W~rk Cirwit Court, and duplic~i~ with ?ax Ass~ssor.)
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