HomeMy WebLinkAbout0847 • Q~:ct~:raYion of I3or~~~ici1.: .icici Girizc.~n:~tiip '
TO TNC STATE ANQ COUNTY TAX l~SSCSSOR. 25p499
Sl . tUCIE tOUN1 Y, FtORIDA: • .
lhis is my declaralio~ of Oomicile and Citizcnship i~ the State of Fto~ida that I am iiling this day in accordante and
~n conformity with Chapte~ 222, Section 22?.17. Florida Statutes.
1 was forme~ly a legal resident of ..Q~_ ~i / ~
ity) (State)
and I resided at ~.1Q~1~ . Howeve~ I have changed my domitile
~ (Street and Number) •
to and am and have been a bona fide resident of the State of Florida since ~,~f' day of
. .
, 19~~, and I reside 'at ~
~ (Street and Numbe~) ~4, ~ ~3~~
FORT PIERCE, SAINT LUCtE COUNTY, FLORtDA '
and this sfatement is to be taken as my declaration of citizenship, actual legal residence 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 ~ 2~499 .
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=T ROCE POITAAf ~
RECORO Yf~ ~jfa
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this Sfate.
;
I FUBTHER CERTIFY that I have no intention to return to my former domic,ile, and 1 intend to remain in FORT ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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- ' .~Lt.~,C„-.J I'S . .t~.~2c~ ~(_o__J
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- (Name)
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~y:;~i~'~~~~j~- ~ ~
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~ ' ~ (Address) '
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" Swo`rn~o~acid subscribed before me this day of ~ , ~ q~ ~ i
'.f'r .~~r , .G~ ~ , _ ' i
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• ~ROGER POITRAS ~
:
RK CIRCUIT COURT Notary Public ~
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dY _ D.C. My Commission expires
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(To be oxoculod in duplicalo and oriqinal (iled witl~ Clerk Circuit Cou~t, and duplicafo with tax Assesso~.)
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