HomeMy WebLinkAbout0467 . Declaration ot Dor~icile and Cjtize~ship
TO TNE STATE AND COUNIY TAX ASSESSOR,
51. lU(:IE COUNTY, FLORIDA: /G+31Sa76
This is my declaration of Dom~cile and Citizenship irt the State of Florida that I am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
~
I was formerly a legal ~esident of _ _ LY~ ~ ~-n ~ ~
(Ci~ ~ (State)
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a nd 1 resided at ~~~_~l ~s~f1~C~_~~1~~J~~v However 1 have changed my domiC~le
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ~ day of
. o~~ a ' `,~w "
_ _ 19~~
; a~d 1 reside at 1/u~~_K~IB" ~~~v'e -
(Street and Number)
FORT PIERCE, SAIN? 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 relinq~ishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Applying, for Homestead V
Entering children in school :
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I FURTHER CERTIFY that ! will compty with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiule, and I intend to remain ln FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permane~tly.
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~ •sf~ p` 'p~= `d~D/S.c/.L. (Name)
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~worn to and subscribed before me this ~ day of ~n , 19 i
. ,
ROGER POITRAS
LERK CIRCUIT COURT Notary Public
i .
Ely , D.C. My Commission expires y
(To be executed in duplicate and original filed with Clerk Circuit Court, and duplicate with Tax Assessor.) ~
- B~aK206 ~ 466 `
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