HomeMy WebLinkAbout0091 . . ~ Decl~r~itic~~~ of pnrnicil~ ~nd Citiiensttip
~
i0 THE STATE AND COUNiY TAX ASSf:SSOR, 249937
Sl . LUCIE COUN1 Y, FtORIDA: '
This is my detfaration of Uomicile and Citizenship in tho State of Florida that 1 am filing this day in actordance and
in conformity with Chapter 222, Seclion 222.17, Florida Statutes.
~
I was fomnerly a legal resident of .1~~ ~ S' _ a~"
(City) (Siate)
and 1 re:ided at However I have changed my domiti~e
~ (Sireet and Number) ~
to and am and have been a bo~a fide resident of the State of Florida si~ce p day of
~ . ~ ~ ~ , 19~, -and 1 reside ~at , Z/ U d.'?~ P_ es. t/ ~ G ~ ~
, (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 Flo~ida.
(Inse~t here any pe~tinent facts,. such as sale of propeny or business, or relinquishment of emp(oyment
at former domicile, ?emoval of family to new domicile, purchase of home, etc.) - ~ ~
Applying, for Homestead ~ . .
sTtWCic COU~Y~u~„
CIfRlc~C ~Ct/!T CObRT {
• - RECOR~ vCL'FIED..,~~ ~
. MMt ~9 ~t 2u 1y'l3 - ~
. - -
24993~
1 FURTNER CERTIFY that I will comply with all other requirements of a lega) resident of tF?is Sfate.
,
' 1 FURTHER CER7lFY that 1 have no intention to return to my former domiGle, and I intend to remain in FORT
i
'i PIERCE, SAIN~ WCIE COUNTY, FLORIDA, permanently. '~V~~So'N oc. fG•
; -
~
. ~
. ,,,)~V~~~~~•••,~I f
, _ ~M~'~~~~~' ~
O •
: ` ~ ~,G ' ~ ' (Name)
~ . Sa~~~! ~ t . G,p .
~ .
'r
: i+~r... ~ ~ ~ -
F,. 1~Lo~ ~d~~ ,~.vP
~ ~,?iir, ~r : ~ ~
`1'id r - ;•v ` ~ ~ (Address)
, ~ ~
- ~U ' ~ - .
~%.,rlirC~ ~ p`.` ~.1 :
~ ~ subscribe efo~e me this day of - 19~! ~t'
. .
~S~-t .
ROGER POITRAS
CLERK CIRCUIT COURT Notary Public
~
~
~ QY D.C. My Commission expires
i
?
(To be oxecutod in duplicate and oriqinal filed wilh Clo~k Circuit Court, and duplicato with Tax Assossor.) , ~
.
aoo~c212 ~
2 : , _ _
~ f _ ~ ti.~ ~w
g .%H ~
i~.~._-.~_:_ - _