HomeMy WebLinkAbout0137 Deciaration -ot Domicile and Citizensh~p
23'~3'75
TO THC STATE AND Ct~UNiY TAX ASSESSOR, ~
51. IUCIE COUNTY, FIORIDA:
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This is my declaration of Dornicite and Citizenship in the State of Florida that 1 am filing this day in accordance and
~n conformity with Chapte~ 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of __~~x~.-__ '
(City) (State)
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and 1 resided at __II~-~---~5'-_~/~Lit/NE~L
_ _ _ _ _ . Howeve~ I have changed my domiCile
(St~eet and Number)
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to and am and have been a bona fide resident of the State of Florida since S_-___- day of
- - 19! and I reside at 2~__171?D~D ~L Vc~ ' _ ,
(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.
(Inserf here any pertine~~t 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 ~tE~ ah~ ~~coRCED
ST. tUCi~ GOUMTr FLA.
ROCE' '~!TRAS
CLERK ~:1:~•J~T CO
Entering children in school : aFCCF~ ,
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NELiyuT w,LL~.~~, ~J o l?f~i~A/V SEP S 9 58 AH'1Z
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C~I R l ST/ iv G A Al N E 1' D I~ A, i~ra~~a3~S
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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 return to my former domic,ile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ ~WtltN fo and subscribed before me this day of _ , 19 7~
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ROGER POITRAS _
CLERK CIRCUIT COURT Notary Public
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By ~ D.C. My Commission expires 1
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(To bQ executed in duplicato and original filed with Clerk Circuit Court, and duplicate with Tax Assessor.)
BOOK~~ PAGE 137
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