HomeMy WebLinkAbout2661 Declaratio~ ot Domtcile and Citi3enship
T~ YHE STATE AND COUNTY TAX ASSESSOR. ~ 2:Y 2.1.3~
Sl. IUCIE COUNTY, FIORIDA:
This is my declaration of Oomicile and Citizenship in the State of Florida that 1 am filing this day in accordante and
~n confon ~~ry with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of _ ' _ laY1tLL~ _Cb~1A1 . _
(Ciy) ~ (State)
and I resided at ~IQ. SyQR.~~_A~l~A~~~, ~0~~.4 !Z`~g, . Ht~weve~ 1 have thanged my domitile ~
(Street and Number) ;
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ro a~d am a~d have been a tiona fide resident of the Stata of Florida since _ day of
---~lJ~w1E - - - . 19Z.~_, and I reside at ~ N E. ~RACK,E1.) KDAD ~
. (Street a~d Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, act~al legal residenca and domicile in the State of Florida.
(Insert here any pertinent facts, such as saie of property or business, or relinquishment of employment ,
at former domicile, removal of family to new domicile, purchase of home, etc.)
~ For Homestead 212_13;
- fILfO AMO RECOR~~~
5T. LUCIE COUMTY '
ROCEa POITR~f ;
- CIERK CIRCUIT COYRt ~E'~~'~ ~
` RECORO VERIFIEO.~..~~ ~
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~Il ~Z 24 ~M'T~ .
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I FURTHEit CERTIFY that 1 will comply with all other requirements of a legal r~sident of this State. ~
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I FURTHER CERTIFY that I have no intention to return to my former domiGle, and I intend to remain in FORT !
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PIERCE, SAINT LUCIE COUNTY, fIORIDA, permanently_ '
. • _ ' B NISL F. -
. • : ';3~; ' ~ ~,,,t~~
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~ . . ~ (Name)
, - :
= 361 NE Bracken Road, Fort Pierce
' (Address) ~
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Sworn to and subscribed before me this 12th _ day of _ July ~ 19 71 ~
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ROGER POITRAS _ ~
CLERK CIRCUIT COURT Notary Pubtic f
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By ' ~-'-'L-~ C- rC~'`'`'`~-~-~~ O.C. My Commission expires ;
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(To b~ ~xecvted in aupiiut~ and ori~inal fil~d witl~ Clnic Grcuit Cou~f, and dupliut~ with Tax Aswsso?.)
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