HomeMy WebLinkAbout0839 Oeclaration oi Domicite a~d Citizenship
• 2~~868
TO TFiE STATE AND COUNTY Tl~X ASSESSOR,
~1. IUCIE COUNTY, FLORIDA
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
~r~ conformity with Chapte~ 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of ,~~e.A_1__L1~.~ LL~A~s2-~~--- -
(C~ty) (State)
- _ ~
and I resided at ~ G~J!!~1~L- However I have changed my domiCile
(Street and Number)
to and am and have been a bona fide resident of the State of Ftorida since day of
V S T------ . 19~n~, and I reside at ~
Z G~Q~ ^..e_ ~T'~~
(Street and Numbe
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 s
~
. i
Entering children in school : ~ ~ '
23'7868
fILEp ~hD RECpRpEp '
- iT. LUCIE COUNTr F~A. ~
ROCCa Pc~TR~S i
OLEAk C~••e,U1i COURT ~
RFC~RO v;F~ F1E~..~.~.~~
.
,
S~P 11 Il 2~ PH'11
~
` ~G
~ ~
~
~ .
1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
1 FURTHER CERTIFY that I have no intenfion to return to my former domiCile, and I intend to remain in FORT ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_ ~
. ~ . - . ' ~t7~-C~i c-e ./~K- Q ~ U
. - - . __e'
_ . - ' (Name)
_ , ~
~ - , _ ~y~a C~
~ : (Address)
~ .
~ Sworn to and .subscribed before me this ~ da of ~~U~ , 19
Y
ROGER POITRAS -
LERK CIRCUIT COURT Notary Public
.
- E3y _ D.C. My Commission expires
;
(To be executed in duplicate and original filed with Clerk Ci~cuit CouN, and duplicate with Tax Assessor.) ~
i'~1(~ ~ ~
- _ - - -
~
>
- ~ y. z ~ _ ~
, .
_
_ ~ :