HomeMy WebLinkAbout0499 I
• i~cct~~r«ti~~~ of [?oii~icite ~~c~t~ Ci~izc~ct~ttip
lU THE STATE AND COUNTY T/1X l~SSESSOR, 2~~5
Sl. IUCIE COUNIY, fIORIDA:
This is my declaralion of Oomicile and Citizenship in the State of Florida that I am filing this day in accordance and
in con(ormity with Chapter 222, Section ?22.17, Florida Statutes.
I was fonnerly a legal resident of e_~-- ~Q ~e r S e
(Ciry) (State)
~ ~
and 1 ressided at _`d ' S 1,~~0 G~- T~ U e t~ cl ~ . Howeve~ 1 have changed my domitile
~ (St~eet and Number) ~
/
to and am and have been a bo~a fide resident of 1he Sfate of Florida since~, B ~ ~~~P 7' day of
- " ~ ` n ~1-C u ~ P ~ , 19~1.._~, and I reside ~at ' S ~V.(~ e ~f p~Y~ v t~ ~ ~ . ~ ~C~ ` t"
~
~ ~ ~ (Street and Numbe~) j I p y
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 Florida.
(Insert here any pertine~t facts,. such as sale of property or busi~ess, or relinquishment of employment
st former domicile, removal of family to new domicile, purchase of home, etc.)
Applying ~ for Homestead ~ .
- Entering children in school :
- itLfD AND R~C4Rp
ST.IUCtE COUNTY f~ -
' " ROCEIt POITRAS ~
~ ClERK CIRCUlT CCUI~T
IIECORO VERIFIED
~ ~ ~ut 2 os PM'73 _
.
. ~ . 25p~s
1 FURTHER CERTlFY that ! will comply with aU other requirements of a legal resident of this State.
I FURTNER CERTIFY that I have no intention to return to my former domiGle, and I intend to remain in FORT
PIERCE, SAIN7 LUCIE COUNTY, FLORI~A, permanently. . " V/ U ~~d t h~
`,~~~....n..~ 9 / ~ / ~
~ ~
;~'U'liT~-='~~0•••, _ . v ~2-~7~i-
:'v~. ~~~i: . G -
' ' ~ ' " (Name)
: _ ~ ~ . ~ ~
= ~ ~ : ~.;i „ = ,
=S. . ~ ~iL :
1 _ (r , •c P ~ ~ _ ~ -
~ ti'~ c • a : j t ~
: cJ~ ! m: t~-S /-V C=eY0 Y ~1 _ UC~~ ~
_ ~'''E f " Q ; ~-6. ~ , O Y
~i,;, - ~ ; r . ~
. ~f,~• ~ (Address)
l ~tis~.: t ~ _
~ .
~~,y~~ -
r~ ~ ~,•cp•., w .
Sworn~fo and.subscribed bef re me this ~ da of •~'%'~/l~U~ -
Y , i9 .
ROGER POITRAS
CLERK GRCUIT COURT Nofary Public
r
f Y- U.C. My Commission expires
~ na .
(Fo ba oxocufad an duplicate and or'~~• .•d wilh Cfor c. ircuit Gourt, and duplicato with Tax Assossor.) i~
.
. - _ _ .
'y~L"y`ro wF ? ` I .~C' 'r ~"`~~1~Ti3.
i,Y 'x ~'i~`~M v f
~ ~ _.3 ~H
~
_