HomeMy WebLinkAbout1449 Deciaration ot Domicile and Citizensi~ip
TO THE STATE AND COUNTY TAX ASSESSOR,
40~3 , •
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51. WCIE COUNTY, FLORIDA: '
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
in conformity wilh Chapter 22~, Seclion 222.17, Florida Statutes.
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1 was forme~ly a legal ~esident of _
~ (Ciy) ate)
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and 1 resided at ~ . However 1 have changed my domi~ile
~ (Sireet and Number) ~
to and am and have been a bona fide ~esident of the State of Florida since L~~~..~- day of
~ ...~~1, ~ _ , 19_1~ and I reside ~at ~ ~ L
(Street a~d Number)
FORT PIERCE, SAINT LUCIE COUNTY, fIORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or ~elinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Applying, for Homestead
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- Entering children in school : ~ v~~
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1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I 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. ~
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• • ~ (Name)
'.J~~f~~:~ .CL~'•
~ _ k' ~~Y ~ ' (i
~ ? _ ' ~ (Address) . ~
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~ ! ,:;;'~~c t~ ' CS~C'~2~ 19~?- ~
~ "~~SvV,qrrr~~A~erid .subsuibed before me this day of . ,
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ROGER POITRAS ,
RK CIRCUIT COURT Notary Public
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E3y G'-~-~-e- D.C. My Commission expires
(To bo oxecutcd in duplicate and oric~inal filed with Clerk Circuit Court, and duplicate with Yax Assossor.) ,
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6UOK 207 P~~~ 14~9
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