HomeMy WebLinkAbout2316 Declaration ot Oort~icile and Citi=~nship
TO 1 H[ STl~TC A~i[~ COUNTY TAX ASSLS:~~OR,
;i IUCIE COUNIY, F10~'.~oA 23~'~41
~his is rny declaration of Dom~ciie and Citi~enship in the State of Horida that 1 am iiling this day in accordance and
~n confarmity w~th Chapter 222, Sect;on 222.17, Florida Statutes.
I was tormerly a legal resideM of L C.Q~L~ _ _ . - -
~C;~y~ tate)
and I ~esided at ~ S~_ jJ0(~1_Q ~[t. V'_+C 0!!~1 1:/ _ . Howeve~ I have changed my domiCile
(Street and Number)
1 PY . i
to and am and have been a bana fide resident of the State of Florida since ~Y~_ _t_~_-__---_- day of
~f_ .
/TU._ ~ - - 2_7- - . 19 and I reside at ~ ~1---~
~~C( Vt ~ ~ ~ _~.'S 1/ ~ - -
~ (Street and Number)
FORT PIERCE, SAINT LUCIE COUN7Y, 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 new domicile, purchase of home, etc.)
Applying ~ for Homestead
Entering children in school : L Q`~ ~n w ~ ~ S C~t aL (
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I FURTHER CERTIFY that I will comply with all other requiremenfs of a legal resident of this State. ~
I FURTHER CERTlFY that I have no intention to return to my former domi " e, and n snd to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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~~wom td and srtF,~cc~bed before me this day of - 2~ 19 ~Z'
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~Rq~~f~. d~o~R~o?s ` -
CIERI~~~.'t~~CU1T COURT Nofary Public
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C~y ~~1~/!~\l-"_~_b~____- _ D.C. My Commission expires
(To be executed in duplicate and original filed with Clerk Circuit Court, and duplicato with Tax Assessor.)
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