HomeMy WebLinkAbout0636 Declaration ot Domicile and Citizenst~ip
239'7'78
TO TIiE STATE AND COUNTY TAX ASSESSOR, , .
Sl. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
~r7 ~ontormity with Chapter 222, Sec!'son 222.17, Florida Statutes. '
1 was (ormerly a legal ~esident of - - -
~ (City) (State)
S o ~ ~«-Q~ ~ -c_•l~ s r _
and 1 resided at ~ " However 1 have changed my domiCile
' (Streel and Number)
to and am and have been a bona fide resident of the State of Flo~ida since - ~~s~ day of
~p-,1 ~ Pa-~'', -~rr' a
" C f- , 19
7Z and I ~eside at /7~ 7 S o-'~/~C'~- S F"
' (Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence a~d 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
- Entering children in school ;
~ ~J ~ ~ - -
~ D~ ~ F LED ANO RECORpED
~ p~ f~. lUC1E COUNTr FI.A.
~ , _ ROCER POITItAS
CLERK CIRCUI~ COURT
RECORO YfR~F1E0
Oct I2 2 3~ PN'TZ ;
.
. .
i ~ 239'7'18 s
~
~
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1 FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
1 FURTHER CERTIFY that I have no intention to return to my former domic,ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~1 ~r ' R.~c~-~d
(Name) ;
;
~i n~ /~2 o s S
_ .
~ ~
. (Address) _
~ - _ - ;
~ ' ~ , ~ i i . .~C ; ~ ~ , , 19_~!
.
~:,.~;Sy~g~~
1w ~1~'•fubscribed before me this day of ~
, * % ' . .
~
_ ~:,~~M• ~ : - ~
cn i ~~~tOGER'P~ijR14~
~,'~."~C1~i~C ~IR~(~IT ~OURT Notary Public .
; si
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By U.C. My Commission expires
~
(To be oxocuted in duplicate and oric~inal filed wilh Clerk Circuit Court, and dupliwto with Tax Assossor.)
aooK 207 N~cE s~ ~
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