HomeMy WebLinkAbout2979 Dectaratio~ ot Domicile and Citizenship
lU TtiE SfATE AND COUNTY T.~X ASSESSOR,
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Sl. LUCIE COUNTY, FIORIDA. .
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Tl~is is rny dec~aration of Dom~cile and Citizenship in the Sta~e of Florida that I am fil~ng this day in accordance and
~n conformity with Chapter ?22, Sedion 222.17, Florida Statutes.
1 was formerly a legal resident of DARBY-_--. - P~-.~i~-----_
(City) (State)
6 Ashborn Road
and I resided at - . - _ _ - - - - - - . Nowever 1 have changed my domicjle
(Street and Numbe~)
to and am and have been a bona fide resident of the State of Flo~ida si~ce __30tM day of
Au~ust ~9-?2, and I reside at __1910 SOUth 35th street
~ (Street and Number)
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.)
Applyingj for Homestead
Entering children in school : Brenda in the 9th grade
. .
F.on~Yd in the llth grade
n RECO~DED '
F~~E~~iL C3uNty S~A'
St. Q G; ~ F~;ti
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RECncR`~`F ~
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I FURTHER CERTIFY that I will comply with all other requirements of a lega) resident of this State.
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1 FURTNER CERTIFY that I have no intention to return to my former domiule, and 1 intend to remain in FORT ~
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g PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanentfy. ~
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~ - ~ ~ (Name) ;
` Doria Mae Adana ~
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~ Swom to and subscribed before me this 1°t day of SeQtenber ,~9~~ i
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R GER POITRAS -
ERK CIRCUIT COUR7 Notary Public
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~ E3y D.C. My Commission expires - _
(To be execufed in duplicate and original filed with Clerk Circuit Court, and duplicate with Tax Assessor.)
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