HomeMy WebLinkAbout2964 Declaration ot Domicile and Citizenship
23~308 .
lU THE STATE AND COUNTY TAX ASSESSOR,
Si LUCIE COUNTY, FIORIpA:
This is my declaration of Oornicile and Cit~zenship in the State of Florida that 1 am fil~ng this day i~ accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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I was formerly a legal residem of _ I~--O Gf~ . 1 S ( A- n/ d.-_ ^ - - ~ ~ . - _ -
(City) (State)
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and I ~esided at d_ 1_______ . Howeve~ 1 have changed my domiule ,
(Street and Number) ;
to and am and have been a bona fide resident of the State of Florida since day of ~
l~i R o~~.,: s c~ ~-s~ : n . '
- - - - 19 : and I reside ~at - J S-A S • ~ s ~rt , ~ • l',ue.n..~.~- ~ i
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actuat legal residente 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 j for Homestead
Entering children in school : '
v ~n~~ • FILED ANI~ RECOROED
` - 1 ~ ~ ST.LUCIE ~~~UlITY fLA.
RQCE= ~ a1TRAS
S . CLE~K :i ;UtT CQURT~~ _
~ ~.~.u~..f' ~ o--a.~ G~.e~.~~. \ 1 ~ a f C ~ R' . c ~ D
~ rn~~ ' SEP I ~ ~ 28 aM ~7Z
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I FURTHER CERTIFY that I will comply with all oiher requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former dornic,ile, and I intend to remain in FORT
PIERCE, SAIN7 LUCIE COUNTY, FLORIDA, permanently.
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~ (Name) ~
~ ke~eM~~r M, dA?,tis.
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~ ( ddress)
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Sworn to and subscribed before me this ~ day of , 19~ v ~
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ROGER PQITRAS - - ~
CLERK QIRCUlT COUR Notary Public ~
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E1y µ S D.C. My Commission expires _
.
(To be exucuted in duplicate and original filed with Clork Circuit Court, and duplitate with Tax Asseswr.)
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