HomeMy WebLinkAbout0136 . Declaration of Domicile and Citizenship
10 THE STATE AND COUNTY TAX ASSESSUR, 23'73'74
Sl. lUC1E COUNTY, FlORIDA:
This is my declaration of Domicile and Citizenship i~ the State of Florida that I am filing this day in accordance and
~n conformity with Chapter 2?2, Section 222.17, Florida Statutes.
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1 was formerly a legal resident of . _ , . '
(Ci tate) ,
and I resided at _%~-?~~~~~L___ ~ However I have changed my domiCile
(Street and Number) ~
to and am and have been a bona fide resident of the State of Florida since ~_~d day of
' ~ ~ ~ i
- 19Z~ , and I reside ~at 3~ ~-~.~s~
(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.)
Applying ~ for Homestead
Entering children in school :
~ ~ .~L~ `7~ `~lio-....~ ~tLED ~4D REC~a~ .
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1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to ret~rn to my former domiCile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
',~~..~NU`IIII~~ ,
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~ ,I.,•~~ Sworn,to and subscribed before me this day of Z
, 19_Z.
~ •
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ROGER POITRAS
~ ERK CIRCUIT COURT Notary Public
~ •
~ ay ~ D.C. My Commission expires
(To be executed in duplicate and original filed with Clerk Circuit Covrt, and duplicate with Tax Asseswr.j
BOOK 206 ~A~E 1~6
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