HomeMy WebLinkAbout0427 i
Deciaratlo~ ot Domicfle and Citizenship ~
TO THE STATE AND COUNTY TAX ASSESSOR, j~j~865
Sl. LUCIE COUNTY, FIORIDA: ~ •
This is my detlaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordante and
in confor.mity with Chapte~ 222, Section 222.17, Flprida Statutes.
,
I was fo~mer~y a legal resident of Atlanta _ (3eorgia
(City) (State)
120? Monroe Drive, ~.E.
and 1 resided at _ However I have changed my domicjle
(Street and Numbe~)
to and am and have been a bona fide resident of the State of Florida since - D._~ID~L~~- day of
1971
,~07l~Y]C, and 1 ~eside at 647 No. 2rld 3treet
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Ho~ida.
(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, pu~chase of home, etc.) .
homestead~exenption
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: I FURTHER CEitTIFY that 1 will aomply witfi all other requiremenfs of a laya) ~esident of this State.
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~ I FURTHER CERTIFY that I have no intention to retum to my former domicjle, and I intend to remain in FORT
~ ~
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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~ i (Name) y Rose J irige
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: f,,'SMt~it~fo al~~wbscribed before me this day of , 19~.~
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; CIERK CIRCUR COURT Notary Public
By "w~ D.C. My ~ommiuion expires
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Ro b~ ~x~suhd in dupliuh and oripi~al Rl~d witb q~l~ Cinvi! Cou~f, aed dupliut~ witi~ Tax Asw~tor.)
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