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. L~~ct:u~tti~n uf Dnr;~icil:: .tttCi Gi~iz~~n~,l~in H
TU TffE STATE AND COUNTY ~AX ASSCSSOR, ~~W IO5
51. WCIE COUNIY, fIORIDA: • ~
~
Tl~is is my detlaralion of Domicile and Citizenship in the State of Florida that 1 am tiling this day i~ accordance and
~n conformity with Chapter 222, Scction 222.i7, Florida Statutes.
.
I was formerly a legal resident of ..i ~u ~~a t_~1LLL_( V~ Y~ ~ il
(Ciy) ~ (State)
and 1 resided at _.~...6L_2__ ',~~?~r 1C -L- ` Q v~ However l have changed my domiCile
- (Street and Number) ~
to and am and have been a bona fide resident of the State of Florida since day of
~ f
m , 19~~, and I reside ~at ~ 9~-5 ~A v f~ c.? t~ v~~ CQ /9 'L
(Street and Number)
FORT PlERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legat residence and domicile in the State of Florida.
(Inse~t here any pertinent facls~ such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicite, purchase of hame, etc.)
Applying ~ for Homestead ~ .
- Entering children in school :
' r c n 4 s r c~/ ~1 v m ~ ~ r, , f r 7 (1
~ < < ~ .
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~-.e (~r~ v~skiti/ 2rr:~ lo~~~sz~ ;j, t/~rJiri~q
P 'ILED ~MD RECOROEO
, ` . , - ~ sT. wciF couarr Fu.
r+ M~/~j P; i G~ ~./~S h ~ c' r 7 ~i !r < Z CIERKCC RCUIT C URj
~ ~ RF.CQRD VERIFIEO i'
~ 18 ! so PN 'T3
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~ I FURTHEI2 CER7IFY that 1 wil! comply with all other requirements of a legal resident of this State.
i
i
r I FURTHER CERTIFY that I have no intention to refurn to my former domiCile, and I intend to remain in FOR7
~
~ PIERCE, SAINT Lt1GEE COUNTY, FLORIDA, permanently.
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Swor~'Yb'~and subscribed before me this day of , 19_y~
~ .
~ ROGER POITRAS
i CLERK CIRCUtT COUKT Nota?y Public
~ ~
8y v•'~ _ ~ D.C. My Commission expires ~
.
(To be oxoculed in Juplicafo and ori;~ina! filc:d wilh Clcik Circuit Court, an ~u i at wilh Tax Assoswr.)
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