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Deciar~tion ot i~omicile and Citizensi~ip
. TO THE STATE AND COUNTY TAX ASSESSOR, ' 2398~'s
Sl. LUCIE COUNTY, FIORI~A:
This is rtiy declaration ot Domicile and Citize~ship in the State of Florida that 1 am filin~ this day in accordante a~d
in conformity wi~h Chaptcr 222, Section 222,17. Florida Statutes. t
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( was formerly a legat resident of _ ~ ~ P _ ~ l(~ `JG~_
~ (C~ty) (State)
h J
and 1 resided at ~ C~c;3./~~ ''~J However 1 have changed my domic.ile
(St~eet and Number)
to and am and have been a bona fide resident of the State of Florida since ,~_~U ~ day of
_
.
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, 19 and 1 reside ~at J ~ l' ~ / ~ •
~ (Street and Number) '
FORT PIERCE, SAiNT LUCIE COUNTY, fLORIDA
oiw' ii~iS aiaic~Tici~i iS i'v vc ioiCci~ oS iiiji v~:C:u:u::v : v: :Y~ :~y _-i ---:1.. •L... Ca~a~ nF Flnri~la,
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domiciie, removal of family to new domicile, purchase of home, etc.)
Applying, for Homestead " ~
- Enterin children in school ;~1 ~lED Akp ~E
9 ~T._lUC1E C4~p~
RK C ROUtt ~
~ ~
RECORp yfRiF~Ep~ ~
. ~~~~y~ ,~a„~~e ~S.~P~
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c-~~.~ / ~ ,~s P '~398~'5
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I fURTHER CFRTIFY that I will comply with all other requirements of a legat resident of this State.
1 FURTHER CERTIFY that 1 have no intention to return to my former domiCile, and 1 intend to remain in FORT
PtERCE, SAINT tUCtE COUNTY, FLORIDA, permanentty.
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, (Name) p 054-¢N
~ ~ ~ 3~ Z~! ~.E~. ~6''~,.
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;'''~ybdrTn t~,+~it~,s~bscribed before me this / ~ ~ay of ~l ~jE ~qF~ ~
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: ~:itOGER
; ~CLERK'CI CUCf pURT Notar Public
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BY ' i ~•C• My Commission cxpires
~ ED .
•
(To b~~ oxocuted in duplicafe and oric~inal (iled with Clork Circuit Court, and duplicato with Tsx Assossor.)
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