HomeMy WebLinkAbout0783 • Qt~ct~ir~~tic~~~ of f~omiciic: :~r~~i Ci:i: c:nat~i~
TO 1HE STAIE AND COUNTY T/1X• /155LS.SOR, 2~7V4S~
Si. lUC1E COUNIY, FLORIDA:
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This is my dcclaration of Domicilc and Cititenship in the Sta~e of Floride that 1 am {iling this day in atto~dante a~d
~n conformily with Chapter 222, Section 222.17, Florida Statutes. •
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I was formerly a leyat ~esident of ~ ~ Rd? 1~ A ~i~ ~ ~~R~~ \ Q
(Ciy) (State)
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rnd 1 resided at S_`Ls A• Q~ ct c L. . 13 ~ v c+~l . v~- ec. c~, However 1 have changed my domiCile
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ta and am and have been a bona fide resident of the State of florida since a 6~ 7 3 day of
~e , 19~, and I reside 'at ~ Y~ a S• 3~~ Ff c Kc e
~ (Street and Numberj
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FORT PtERCE, SAINT tUGtE COUNTY, flORIDA
and fhis siatement is to be taken as my declaration of citizenship, actual legal ~esidence and domicile in the State of Florida.
(Insert here any pertinent facts,. such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Applying, for Homestead .
Entering children in school : ~
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~ . ~.v~e~g ~^ye 'LJ~+d~~t ~
_ ~ ~ ~ ~ ~ ~ ~ ~w.~ ~ d 1 ~
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fRK CIRC{~1t ~t ~
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. 250452 .
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1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
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1 FURTHER CERTIFY that 1 have no intention to return to my former domiGle, and I intend to remain in FORT
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PiERCE, S~{((y.j~LUC1~.~0UNTY, FLORIDA, permanently, ~
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Sworn to and subscribed before me this day of _ i~~s~U~ , 19~ f
ROGER POITRAS ~
CLERK CIRCUIT COURT Notary Pubiic _
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eY - ~ D.C. My Commission expires
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(To be oxoculed an duplicate and r• ~:nal fited with Clork Circuif Covrt, and dupticato wifh Tax Asseswr.)
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