HomeMy WebLinkAbout2706 De~laration ot Domf~ile and Citisenshlp
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FIORIDA:
Th~s is my cieclaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
~n conformity with Chapter ?22, Section 222.17, Florida Statutes
I was formerly a legal resident of Sp~a _ N~. J~
(C;ty) (State) '
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and I resided at T 1l~ld~'ed Ih'ive However 1 have changed my domiCile ~
(Stseet and Numbe~)
to and am and have been a bona fide residpnt of the State of ~lorida since seP~• ~ _ _ day of
, 19_ 7Q , and I reside at RA~~ ~~~P4~ St LuC~e. _
(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 Flo~ida. ~
(Inserr 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.)
Est°?~'_j °~;^e ~aidency aad fi2ing for homestead ~zemption ~
FIlEO ANO RECOR~~a
:Y. LUCIE COWITY A-
QOCEa POITRA8
CLEAK CIRCUIT COUQT
RECORD VERIFIEQ~....~~
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1 FURTHER CERTIFY that 1 will c~ply with all other requirements of a(ega! resideni of this State.
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~ I FtJRTHER CERTIFY that I have no intention to return to my former domic,ile, and I intend to remain in FORT
~ PIERCE, SAINT lUCIE COUNTY, FLORIDA, permanently_
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~ - (Name) ]~in C{C I,epoTe .
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~ - ~Address)- -
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~ ~ 2T Ootober TO
~ Swor~ to ar[d wbstribed before me this _ - - day of - - - _ _ 19---
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~ ROGER ~OITkAt -
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~ C1ERK CiRCVIt;~ T Notary Public
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fr By D.C. My Commission expires
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~ (To b~ ~xecut~d in duplicat~ and oripin~l fil~d with Cl~rtc Clrcuit Court, and dupl~uN with Tax Ass~ssor.)
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