HomeMy WebLinkAbout0205 Declaratio~ ot ~or~icite and Citizensi~ip
TO TNE STATE AND COUNIY TAX ASSESSOR,
Sl. lUC1E COUNTY. FIORIDA: ~""'~v
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This is my decl~ra~ion of Oomicile and Citizenship in the State of Florida tha~ I am filing this day in accordance and ~
in conformity with Chapter 222, Section 222.17, Florida Statutes. {
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I was formerly a legal resident of _~plL
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and 1 resided at ~r?E~ . However 1 have changed my domiCile
(Street and Number) ~
to and am and have been a bona fide resident of the State of Florida since _ _ r~~~ day of
;
~QG i . _ , 19~?-, and 1 reside ~at ~d25 i'~~~~~
. ~ (Street and Number)
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FOR7 PIERCE, SAINT LUCIE COUNTY, fLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in ihe State of Florida.
(Insert here any pertinent facts, such as sale of properiy or busi~ess, or relinquishment of employment
at former domicile, removal of family to new domicile, pu~chase of home, etc.)
Applying, for Homestead
- Entering children in school ; ~~qM~~ Lr-~} ~~e~~?T
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• ST. ~OCERCP01?RAS
CLERK CIRCUIT COURT ~
RECOR~7 VERIFIED
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E - 239488
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I FURTHER CERTIFY that I will comply with all other requirements of a lega) resident of this State. j
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I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT 3
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PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanent{y. / ~ % 5
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- ~Qso~bscribed before me this day of ~C ~.s.~~P~- , 19 ~
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CLERK CIRCUIT COURT Notary Public
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E3y D.C. My Commission expires ~
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(To be oxecutcd in duplicate and original (ilcd with Clork Circuit Court, and dupliwto with Tax Atsossor.) ;
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