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. Q~ci~ir~:tian ot Dorn~cile ~-~c~d Citi~en~tiip . ;
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~O THE STAIC AND COUNTY Tnx A;SESSOR, 2~~
51. IUCiE COUNIY, FIORIDA:
This is my declaration of Oomicile and Citizenship in the State of Florida that 1 am filing this day in accordance and ~
~n conformity with Chapter 222, Scction ?24.17, Florida Statutes.
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I was forme~ly a tegal resident of
. (City) 'tate)
However I have changed my domitile
ar?d 1 resided at ~ a • ,
- (Street and Number) -
to and am and have been a bona fide resident of the State of Florida since 1 day of
. ~ ~ ~ ~ t ~ ot ~`c~ - ~ . ~t~- ~
~S~-! 19~, and I res~de at
~ t and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this siatement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Flo~ida. .
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of emplcyment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Applying~ for Homestead ~
- Enterinq children in school :
sT IUCIE COUNTY f~~
~ ~ CtERR
C~tCUiT COURT ~
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- M~ 10 3 ki PM'73
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I FURTHER CERTIFY that I will comply with all other requirements of a lega) ~esident of this State.
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I FURTHER CERTIFY that I have no intention to return to my former domic,ile, and I intend to remain iq fORT ~
eo nf /~RmA~1/ L e v~~NfO~ ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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3ubscribed before me this ~ d day of , ~v~ , 19,c=s`
ROGER POITRAS
CLERK CIRCUIT ~OURT Notary Public
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~}y D.C. My Commis:ion expires -
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(To be oxecuMd ~n duplicalo and c. r~al f+led wilh Uerk Circuit Court, and duplicato with 7ax Assessor.)
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