HomeMy WebLinkAbout1193 . Declaration ot Domicile and Citizenship 2~136 ~
TO THE STATE AhD COUNTY TAX ASSESSOR, ~
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Sl. LUCIE COUNYY, FLORIOA: r
This is my decla~ation of Dom~cile and Citizenship in the State of Ftorida that 1 am filing this day in accordance a~d
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in confo?mity with Chapter 222, Section 222.17, Florida Statutes.
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1 w a s o e ~ y a e g a l e s d o f
(C;ty) (State)
However I have chan ed m domiCile .
and 1 resided at ~?~'~L_-~LL~.~~_-_.- 9 Y
(St~eet and Number)
to and am a~d have been a bo~a fide resident of the State of Florida since day of
191~_, and 1 ~eside ~at 1~2Q~ ~V~
(Street a~d Number)
FORT PIERCE, SAINT LUCIE COUNTY, FIORIDA
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 j for Homestead ~ ~
Entering children in school :
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COA~AZ
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i I FURTHER CERTIFY that 1 wilt comply with all othe~ reqvirements af a legal resident of this State.
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; I FURTHER CERTIFY that I have no intention to return to my former domic,i(e, and 1 intend to remain in FORT
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f PiERC€,~,$/,~lfy~ Et1CIE COUNTY, FLORlDA, permanently. ~
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' Swom to and subscribed before me this ~o day of ~~'''jl~~~ , 1972
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; ROGER POiTRAS
~ CLERK CIRCUIT COURT . Notary Public
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By <uu D.C. My Commission expires
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; (To be execufed in duplicate and original filed wilh Clerk Circuit Court, and duplicate with Tax Assessor.)
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f k ~6 1~.90
! 600K PAi?~ ~
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