HomeMy WebLinkAbout0862 D~claratio~ ot Domicil• and Citis~nship
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IIKIE COUNTY,.fIORIDA:
This is my declaration of Domicile and Citizenship in the Stete of Florida that 1 sm filin9 this day in attordsnoe snd
~n conformity with Chapter 222, Sectio~ 222.17, Florids Statutes.
I was formeily e legel res~denr of __BreezewOOd!______ _A___ P@riri _
(Ciy) ~ (State)
St82' ROUte ~~„~ever 1 have chanyad my domic~le
and I resided et - _ _ -
(Street and Number)
to and am and have been a bona fide ~esident of the State of Florida since 13 t _ day of
_NQv_e~ber t9 70 , and 1 ~eside at Rt 1 Boa 9
(Street and Number)
FORT M~CE, SAINT LUCIE COUNTY, RORIOA
and this statement is to be taken as my declaratio~ of citizenship, actual iegal residence and domicile in the Staro of Horida.
-(Insert here any pertinent facts, such as sale of property or business, or relinquishme~t of employment
at former domicile, remova! of family to r?ew domicile, purchase of home, etc.)
Establishing residence and applying for homestead
2C 2~~2
~~L`~~E COUNSY f~~'
~pCER POIT1tAS ~t
IlECO~?~ ~ERif IED.••r~
a a 54~•1~
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~ I RJRTHER ~ERTlFY that I will aomply with all other raquiremenh of a le~al resident of this State.
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~ . i FURTHER CERTIFY that I have no intention to retum to my former domicjle, and 1 intend to remai~ in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ :~izift'::••. . } ~vY?
. : (Name)
_ _ ~ ''l•~..""-. Carl E. phm
" - " , OJL `yi j-s..~
~ T ~ - . _ ~ y ~o~udi s e Rohm
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~ Sw~,in .to and subxr~bed before me this 4 th day of January ~ ~q 71,
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~ ROGER ?OITRAS
~ CIRCUIT OIJRT Notary Public
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~ BY D.C. My Commission expires
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~ (To b~ ~x~ar?~d in dvpliul~ and orioinal fil~d with Ct~lc Grwi~ Court, and duplicah with Tax A~or.)
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