HomeMy WebLinkAbout2411 3
Declaration ot C~omicile and Citizenship
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10 TNE STATE AND COUNTY TAX ASS[SSOR, _
~l. tUCIE COUNIY, FLORIDA:
This is my declaration of vomicile and Cit~zenship in the Sta~e of Florida that 1 am filing this day in accordance and i
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~n conformity with Chapter 222, SeUion 222.17, Florida Statutes. ;
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I was formerly a legal resideM of ~-~--~-`~~!~.'S-_----.---- ~
(C;ty) (State)
and 1 ~esided at _?_~~6_%v~?iei`~_9!v~~ s~__-___- However I havechanged my domiCile
(Street and Number) ~ ~
ro and am and have been a bona fide resident of the State of Florida since !~y~"~!~+'~ --~//~(/7`/`~ _ day of
~7~~~/~ - ~ l~~__, and I reside at --~3 ~~Nf~l ?iE~~/l/G
(Street and Number)
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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 new domicile, purchase of home, etc.)
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Applying j for Homestead
Entering children in school :
~'~~c~/qs ~0 ~q~/D ~,e ~'tf.'4,PrffE.ch's ~Ju~c- c ~ . a/c o~r9~'o~/r
.J~ <i,~~ '`~Ii Co,P,o~~t'~`F /{/,~~1~-,' ~ c,~,P~-,d~iz c i~~! ~o~os., ,,c~ ~
f1~E0 ~Ni~ ~fCOR0E0
ST. LUCiL y~UM7Y flA.
AGG[< <~~?R~?5
CI:RK ~ = CuIT COURT
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Auc 30 !0 52 ~N'72
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State. ;
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~ 1 FURTHER CERTIFY that 1 have no intention to return to my former domi~ile, and I intend to remain in FORT
PIERCE, SAINT tUCIE COUNTY, FLORIDA, permanently.
- ' • x ~t~ ~
t , ''y:;,
" . Name ,
~ _ Glen Ca~~pen~er ;
~ . ~ . _ _ ~ . ~ : : Ca,ye.~~L ;
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~ -:~'r~ . . ' ~ . = 2 ~ r~,~r9,~~~v~ '
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. ~ (Address)
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~ ^ : b ' 38 ' Augu st 72 '
~ Swofti°~o~and subscribed before me this day of ~ , 19 . ;
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ROGER POItRAS -
CLE CIRCUIT COURT Notary Public
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By ~ D.C. My Commission er.pires
(To be executed in duplicate and original filed with Clerk Circuit Court, and dup{iwte with Tax Assessor.)
- eoa~ 205 ~a~ 2411
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