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Declaration ot Domicile and Citizenship
TO THE STATE A~vU COUNTY TAX NSSE~VK,
51. lUC1E COUNTY, FIORIDA:
This ~s my declaration of Dom~c~le and Cit~zensh~p in the State of Florids that I am filing this day in accordance and
~n conformity w~th Chapter Z22, Section 222.17, Florida Statutes.
~ was formerly a legel res~den~ of Silver~ringa xer~lnnd _
~C;ty~ (State)
and 1 resided at ___9909 $1drie~ ROSd _ However 1 have changed my domicjle
(St~eet and Numbet)
ro and am and have been a bona fide resident of the State of Florida since ~_?4th_ day of
June 19 , and 1 reside at 124 Solida prive, Port St. Lucie
- - (Street and Numbet)
~ORT PIERCE, SAINT LUCIE COUNTY. FLORIDA
and this statement is to be taken as my deciaration of citizenship, actua{ legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or ~elinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
219963
Homesteed Eaemp~ion
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I FURTHER CERTIFY that 1 will comply with all other requirements of a leqal resident of this tate.
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I FURTHER CERTiFY that I have no intention to retum to my former domiule, and I inte~d to remain in FORT
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~ PIERCE, SAIN? LUCIE COUNTY, FLORI~A, permanently.
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~ 3~ ~~'v~: . Carl J. Chite
_ 124 Solida Driv~, Fort St. Lucie
i~~F •.~~~~*s (Address)
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'~rr~; ~t3'rn to and subscribed before me this day of •~9
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- ROGER POITRAS
~;4 CLERK CIRCUIT COURT Notary P~blic
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gy ~O~"`'~' D.C. My Commission expires
~ (7o be executed in duplicate snd original filed with Cl~rk Grwit Court, and duplicate with Tax Assessor.)
~ °~eoK197 P~~2118 ~
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