HomeMy WebLinkAbout0981 Declar~tion ot Qomicile and Citizen~liip
TO THE STATE ANU COUNTY TAX ASSESSOR,
51. IUCIE COUNTY,' FLORIDA: • ~W~~
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in atcordance a~d
in conformity with Chapte~ 222, Section 222.17, Florida Statutes. j
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I was formerly a legal resident of -vl~l~ ~I , .
„ ~ ~City~ (State)
~0~02~ .
~ .
and 1 resided at _ ~ . However 1 have changed my domiG~~
(Street and Numbe~) - ~
to and am and have been a bona fide resident of the State of Florida since =~~~~~_o`~•~ day of
~ _ , 19.~?, and 1 ~eside ~at ~ ' ~ ~'~`N ~ ^ ~
' (Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Inse?t here any pertinent fatts, 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 Y
- Entering children in school :
4
~ - ~ ~E ~+~a R~ ~ .
~ ~i~. ~ci~ cou?~r
O~fii ~O~TR~j
CLERIC C~qCU1T CO!{RT ~
Rf.CpRD VEAIF~[D
. • Qct !J I oi PN'~1
.
i
~ 240015
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
1 FURTNER CERTIFY that I have no intention to return to my former domiule, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
- - (Name)
E .
`V~ ~'r q~
~ ' . ~o
F~Y .•y~~~:. . '-'~~.~~1'~r~ . ~
~ ~ G ;1~• s .
- .
3~ _i:z - , i p ~ ' y: - (Address) . _ i
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Nt f~` • Q ~ - . ~J'S~
. . ~ ~ . : .
.,Sv~orn. `•and'~ribed before me this ~ day of l~` {O r , 19~L
. . ,
.
•~~'~~..G~'~.'~~ . -
ROGER POITP.AS
CLERK GIRCUIT COURT Notary Public
. ~
By ~ D.C. My Commission expires
(To be oxocuted in duplicate and oric~inal filed wilh Clork Circuif Court, and duplicato with Tax Assossor.) ~
~o~K 2U7 M~ 981 °
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