HomeMy WebLinkAbout2241 Declaration ot Domtcile and Citizenship
TO THE STATE AND• COUNTY TAX ASSESSOR, ~~Or~
51. IUCIE COUNTY, FIORIDA: ~
This ~s my declaration of Dom~cile and Citizenship in the State of Florida that f am til~ng this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
Aoylaton l~~ass.
I was formerly a legal ~esident of _ _ _ _ _ _ _ . _ _
(C;ty~ (State)
. ~
410 Se~rall Street
and I resided at _ _ . ~ _ _ _ _ _ Noweve~ I have thanged my domicjle
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since Nov. 20, 197Q day of
_ 19_____ and I reside ar 619 _Coconut Avenue
(Street and Number)
Ft. Pierce
FORT PIERCE, SAINT LUCIE COUNTY, fIORIDA
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 new domicile, purchase of home, etc.)
Establishing residencY for homestead
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RECOA^ ~EQtf 1E0
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~ 1 FURTHER CERTIFY that I will comply with all other requirements of a legal ~esident of this State.
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1 FURTHER CERTIFY that I have no intention to return to my former domic,ile, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ (Name)
~ ;,~~;.•i Helen P. Forrest _
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. ' ~ (Address) - - - - -
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~ ~ . ` 1R February 72
`J~ '•,,~wOrt~ ~Q;arid ~ctibed before me this day of - , 19 .
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CLFRK CIRCUIT COURT Notary Public
By ^ D.C. My Commission expires
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(To b~ ex~cut~d in dupliut~ and oripinsl ~il~d with Cbrk Grcuit Court, snd duplicats with Tax Ass~ssor.) ~
A T~l~c ~
:~s tio- 73 •