HomeMy WebLinkAbout2182 Declaration ot Domicile a~d Cltizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
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Th~s ~s my declarat~on of Dom~ufe and Gtizenship in the State of Florida that I am f~l~ng this day in accordance and
~n conformity w+th Chapter 222, Sect~on 222.17, Florida Statutes.
1 was formerly a ~egal res~dent of Chicago I11 •
(C;ty) (State)
8220 SOLith JefSrey Bl~d, However I Fiave chan ed m domicile
and 1 resided at _ - - . 9 Y
(Street and Nurnber)
ro and am and have been a bona fide resident of the State of florida since 22ba day ot
July , 19__ 71 , and I~eside at 1817 South 26th street
(Street and Number)
FORT PIERCE, SAINT IUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actuai legal residence and domicile in ihe 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 new domicile, purchase of home, etc.)
Establishin~ reaidence and ~pplying for hoaestead
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" I FURTHER CERTIFY that I will comply with all other requirements ~f a legal resident of this State.
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~ I FURTHER CERTIFY that 1 have no intention to return to y former domic,ile, and I inte o emain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanentfy. ~
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, _ . - -
. ' (Name)
~ . r.llhu B. SCQtt
~ ' ' - (Address)
~ Swor~ tp end subscribed before me this ______12th day of -____!Ta??UBTf , ~q_3_~
.~S .
itOGER POITRAS
_ K CIRCUtT URT Notary Public
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= By ~ D.C. My Commission expires _
(To be executed in duplicate and original filed with Clerk Circuit Court, and dupliute with Tax Assessor.)
~ r~a sooK1~8 Pac:2~79 _
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