HomeMy WebLinkAbout2099 Declaration ot Domicile and Citizenship
TO THE STATE ANO COUNTY TAX ASSESSOR,
Sl. WCIE COUNTY, FIORIDA:
This is my declarat~on of ~om~cile and Citizenship in the State of Flonda that I am filing this day in accordance and
~n conformity with Chapte~ 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of . _ _ _ _ __]~~th--$el~~g~e --~B~F-~O-p~
(City) (State)
and I ~esided at lOTS Olyiplt! ROad Fioweve~ 1 have changed my domicjlc
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _ 28th - day of
- --~eCP.~ber - 19?~„ and 1 reside at ___'~~Q_ SO i dA nri ve pc~rt_~~. _-jiL1C~@
(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 Florida.
(Insert here any pertinent facts, such as sale of property or business; or relinquishment of employment
at former domicile, removal of family to ~ew domicile, purchase of home, etc.)
Eetabliahing reaidence and applying for homestead
~ ~c~iiuaF couwTY F°i~
CLEF,K C RCUIT COURT
RECORD VFk;f~EO~
~ 1 I I 36 PN '11
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~ 222~5
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~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of ihis State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domic,ile, and 1 intend to remain in FORT
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~ PIERCE, SAINT LUCIE COl1NTY, FLORIDA, permanently.
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~ ' . ~ - J I~:~%JG~C~t ~
x° . ~ (Name)
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~ ~ Yiathiaa C. Helbacl~
~ ~1~i1~_,___~.c - - - -
~ ~ ~ . . cAS~d
~ . ' ~ Tl~ereea Helbach ~
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Sworn to and subscribed before me this l~
tb day of , 19_~.2
~Y~
ROGER POITRAS
- CIRCUIT COURT Notary Public
' By Q~~~ ~~'~~~`'l~-~ D.C. My Commission expires
~ (To be executad in duplicaro and ori~inal fi{ed wifl~ Cl~ek Grcuit Court, :nd duplicah with Tax As~sor.)
ho. ~ 3 ~iUJK '~`.,~~V~
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