HomeMy WebLinkAbout1541 . C~~:ct~~r~tir,iti ot [~~rnicil:.• at~:~ Ci:i~.c:n`~ttin
250966
TO THE STAiE AND COUNTY Tl1X ASSCSSOR,
51. IUCIE COUN1 Y, FLORIDA: '
This is my declaration of Oomicile and Citizenship i~ the State of Florida that 1 am filing this day in acco~dance and
~n conformity with Chapter 222, Section 222.17, Flo~ida Statutes. O,'ao~
1
I was formerly a legal ~esident of ~~f
. ~ ~ (State)
and I resided at ~~L~~- ~'v`~ . However I have changed my domiCile
~ (Street a~d Number) ~
to and am and have been a bona fide resident of the State of Florida since ca7~ day of
~~_1- , 19~% , and I ~eside ~at • /~O ~ C~ rie ~~,s' /q ~i'~
-
(St~eet and Number)
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.
pnsert here any pertinent facts,. such as sale of property or business, or relinquishme~t of employment
at former domicile, remoya) of family_ to new domicile, purchase of home, ett.) ~
- . 250966
Applyingj for Homestead ~ ~
r~~~a
c ~sur~~vR~~.
- Entering children in school : a1.E~~ ~iRC4~T qQURT
REQQRD Yfklil~p~~~
. . Ar~ Z f1=y PN'T3
-
~ ~ • .
1 FURTHER CERTIFY that 1 wil) comply with all other requirements of a(egal resident of this State.
1 FURTHER CERTIFY that I have no intention to return to my former domiCile, and I intend to remain in FORT
PiERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~ '
, ' -c I~L 1
• j J~~. C p ~ (Name)
~o~.~~,••,~ ••c `I o ~ ~ % ~q~(
~ J K S ~ G~ " v~ ~
~ " f"`-:.~ : ~ ° ~ - ~'T f-~ ~',e c S~ s~
~ ~ 3 • < (Address)
~ • ` ° ~ ~
a _ • - ~ ~3
~''•.~S~l?crrn~io rn~.~Subs'tribed before me this - day of ~~R~ L-- , 19 ;
.
" , h••t...~.....•• !
ROGER POITRAS - 4
LEFtK CIS2CUIT CG Notary Public
• tr
Dy °`'~'lu~ D.C. My Commission cxpires ~
~
(To be oxoculod in dupficalo anJ ori~inal (ilcd wilh Clork Circuit Court, and duplicato wilh Tax Assossor.) .
~~~R! ~~G P~,Cf ~,SY~
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