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• U~:cl~3r~~Ei:??~ vi [~orr~ir,il~ ~sn;i Ci:izen~h~n
10 THC STl~lf: ANU COUNTY TAX l~SSCS,SpR, ~~C~~ ~
S? . lUC1E COUMY, FLORIDA: ~ ~
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This is my declaration of Domicile and Citize~ship in tho State of Ftorida that I am fiting this day in accordance and `
~n conlormity with Chapter 222, Section 222.17, Florida Statutes.
I was forme~ly a legal resident of __l/~ ~ _ • - _
(City) (State)
and t resided at _.~3 ~ '~o? q' ~ ,~i_ ~ a. However 1 have changed my domic,ile
~ (Sireet and Number) ~
to and am and have been a bona fide resident of the State of Florida since ~J• day of
- c- , 19.~! and I reside ~at ~ m0 8 So . 3 0f..~ s f_ •
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FIORIDA _
and this statement is to be taken as my dectaration of citizenship, actual legal ~esidence and domicile in the State of Florida.
(Insert here any pertinent facts. such as sale of propery or business, or relinquishment of employment
at former darriicile, removal of family to r?ew domicile, purchase of home, etc.) -
Applying~ for Homestead ~ .
- 1.
r cEO ~MO eec ~
s;• ~uc~E coukt~r
~ CLERK C RCUIT
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U~~ .,11 ~
~ RECORO YERIFIEO ~ 1~'`
- ' -
~ ~ 3 PM'13
2505i2
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1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTfFY that I have no intention to return to my former domi~ile, and 1 intend to remain in FQRT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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S~orQiv subscribed before me this ~ day of - ~ ~ , ~qz~
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ROGER POITRAS
CLtRK CIRCUIT COURT Notary Public
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QY O.C. My Commission expires
~ eoo~ 212 PacE $67
(To be oxocuiod in dunlicale anJ o~iginsl filad witil~ Clork Circuit CouN, and duplicats with Tax Assossor.) . '
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