HomeMy WebLinkAbout1191 ~ Declar~~tion o! Qomicile and Citizen~l~ip
TO THE 5?AT~ AND COUNTY TAX ASSESSOR, w,~n .
IGr ~)1~''~
51. LUCIE COUNTY, FLORIDA:
This is my decla~ation ol Domicile a~d Citize~ship in the Sta~e of Florida ti~at I am filing this day in accordance and
in conformity with Chapter ?22, Section 222.17, Florida Statutes.
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. ~ ~ ,
1 was formerly a legal ~esident of _
~ (City) (S t )
and 1 resided at ~C~-~~ L However 1 have changed my domi~ile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _~_.____-1 da of
Y
~ - , 19~
y , and I reside ~at 3 v ~a ~ - ~ - ~~~+--c.~-
~ (Sfreet and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
a~d this statement is to be taken as my declaration of citizenship, actual legal ~esidence and domicile in the State of Florida,
(Insert here any pertinent tacts, such as sale of property or business, or relinquishment of employment
at former domicite, removal of famity to new domicile, purchase of home, etc.)
Appiying, for Homestead ~ ~
- Entering children in school ; ~
p _ frLEO aMO RE~QRpEo
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Kciacuii cou
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I FURTHER CERTIFl( that I will comply with all other requirements of a legal resident of this 5tate.
`
' 1 FURTHER CERTIFY that 1 have no intention to return to my former domicite, and t intend !a remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
I
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(Name)
~z v/d C'~- . E/~ s
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~~\Q;~ U ~ T, CO'• . (Address)
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_`J, ` ~ ~I'~•G: . ~ .
Swor~r ~~i s~rbscribed betore me this day of ~q~
-a ; ~ ~ ; . ' '
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~ .,'-ROGEjt~ •pbITRAS
ZtERk CIRCUIT COURT , Notary Public ~
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; 4Y ~ ' ~ ~D•C. My Commission expires
~
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~ (To be oxocuted in duplicate and oric~inal filed with Clerk Circuit Courf, and duplicato wilb Tax Assossor.)
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