HomeMy WebLinkAbout0480 • Q~cl~u~atinn ot t3ornicile ~~nd Citi=c~n:;hip
Tc~ THE STA1C AND COUNTY TAX ASSESSOR. ~
250~i4
51. IUCIE COUNTY, FIORI~A: :
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lhis is my declaralion of Domicile a~d Citizenship i~ the State of Flo~ida that 1 am (iling this day in accordance a~cl
~n con(ormity with Chapte~ 222, Scction 222.17, ftorida Statutes.
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! was formerly a legal resident of _
(City) (State)
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and 1 ~esided at !%[9-~7L~- However I have changed my domiGle
~ (Street and Numbe~) ~
to and am a~d have been a bona fide resident of the State af Florida sirxe ~3d day of
, 19 , and I ~eside ~at , '
~ (Street and Number)
FQRT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual lega) residence a~d domiciie in the State of Florida.
(Inse~t here any pertinent facts. such as sale of property or business, or relinquishme~t of employrr~ent
at forme~ domicile, removal of family to new domicile, purchase of home, etc.)
Applying or# Homestead ~ ' .
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. - 250214
f FURTHER C6RTIFY that I wil! comply with al! other requirements of a legal resident of this State.
i I FURTHER CER7IFY that I have no intention to return to my former domicjle, and 1 intend to remain in FORT
! PlERCE, SAlNT LUCIE COUNTY, FLORIDA, permanently. " ~
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'"~rc~~=~p?~nd subscribed before me this day of _ e~~~l~U/~ ~q~,~
.
ROGER POITRAS
CLERK CIRCUIT COURT Notary Public
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QY ~ D.C. My Commission expires
80ox PAGE .
(To be oxocuted an duplicafo aad c•~na1 filed wilh Clerk Ci~cuit Court, and duplicato with tax Assessor.) ~
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