HomeMy WebLinkAbout0227 ~
Declar~tion ot Domicile and Citizensttip
TO THE STATE AND COUNTY TAX ASSESSOR, - ~,A~O~
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Sl. LUCIE COUNTY, FLORIDA:
This is my declaration of Dornicile and Citize~ship in the S1ate of Florida tliat I am filing this day in accorda~ce and
in conformity with Chap~er 22?, Section 222.17, Flo~ida Statutes. ~ '
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KA~~~~~ Q~AKtis i~.~
I was formerly a legal resident of
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C'`T ~ ~Dx 6~~a ~ a a ~
and i resideci at ..~~wa~~~ ~~wvc ~~~oi~ya:v .T.l 4V~~N\~~~:
(Street and Numb~r)
to and am and have been a bona fide resident of the State of Florida since day of s
p X
~ ~ ~ 1 t' , 19~ ~ , and 1 reside ~at R~ ~ ~ ~
' (Street and Number)
FORT PIERCE, SAINT LUCIE COUN~Y, FLORIDA
and this statement is to be taken as my declaration of citizenship, adual legal residence and domicil~ in the State of Fiorida. ,
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(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
- Entering children in school :
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1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State. '
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I FURTNER CERTIFY that 1 have no intenfion to return to my former domiule, and I intend to remain in FORT ~
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PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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;•~r ~~c~ubscribed before me this day of
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;(~lQGER QI S' ~
~'~OURT Notary Public t ~
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E3y ~ ~ D.C. My Commission expires _ ~
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(To bo oxocuted in duplicale and oric~ina{ filed with Clark Circuit Court, and duplicatu with Tax Assessor.)
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