HomeMy WebLinkAbout2216 _ t
i
Decla~ation ot Domicile a~d Citizenshlp ~
;
TO THE STATE AND COUNTY TAX ASSESSOR, '
:
_
51. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and ~itizenship in the State of Florida that 1 am filing this day i~ sccordance and
in rnnformity with Chspter 222, Section 242.17, Flo~ide Statutcs.
I was forme~ly a legal ~esident of ~tp.Y_BlAnB ~ Floride _
(City) " (State)
511 E lsldo Street .
and 1 resided at _ Howevsr 1 have changed my domicjle
(Street and Number) '
b and am and have been a bo~a fide ~esident of the State of Florida since 10 day of
1305 Florida A~e.
_July_ , 1469 , and I reside at (gtreet and Number)
FORT PIERGE, SAINT LUCIE COUNTY~ RORIDA
and this statement is to be taken as my declarotion of citizenship, actual lega) residence and domicile in the State of Horida.
(Insert here any pe~tinent facis, such as sale of property or business, or relinqui~hment of employment
at former domicile, ~emoval of family to new domitile, purthase of home, ett.) ~
Eeteblishing residence and epplying for homestead
~ Fn.EO aN0 RECORDEO'._.
ST.RECORD V~RI
YED`A~
191565
'j '70 MAR Z6 PM ~ : 45 .
; - ~
~ _ i-OITRAS
CLERK CIRCUIT CO .
1 FURTHER CERTIFY that 1 will comply with all othe~ raquiremenri of a leyal res~dent of this Stste.
I FURTHER CERTIFY that 1 have no intention to retum to my former domicjle, and 1 inte to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLQRIDA, permanently.
: ~ . ~.s~C
;~~~iiti:t(lt~j~~ ~I.~<= , (Name)
y~~ , , ~ .
u 1~'~:-CQ~ Karen L. ~ioates ( Mrs Francis )
~ ~i=~.•;•...:; . ~i ' -
~Q~~ .~U+~ r,~. -
~ :G:
? 3'J:
x="-_~'~C~;
: ~a
:
`
,~~.'r.. r'~ ~~t~~/r~~
E I 3 ` ~ R
~ :ji•'~~~~f`,~~ ~s p 4. _ (Address) #
~ _~:t ~~i.~ ~cJ',':''~~~s`~= )
: ~?~Si r~~, ~ . > ~ Q ~
;'N-'" ~r ~
41~"i r?. iJ" - ~
v, 26th March
~~"y'" ~ ,svbxribed before me thia day of . 1~~~ • ~
~_+r:.' f A~~• ~ ? ~
~ ~ 0~:
r! 4 ~ ~
,,~/!!~I~}~ t~EStt 2:'~~ .
RO(i~ ~rO1TRA5
~ CtRCU1T COURT Notary Public ~
~ gy ~L~%~u~ ~ D.C. My Commission expires
~
~
~ (To b~ ~x~cuhd in dupliub and ori~inal flled with Cferlt qrwN Court, and dvpliuta witi~ Tax A~sasor.)
y"R
, a 600#~ PAGt =
_ _ _ • - - . . _ X~
~ ~ e
_ ~~~-F
~ 2,~ _f~~ ~ ~ x-~ . s.f. .