HomeMy WebLinkAbout1579 ~ , .
DeClaratian ot Domicile and Citizensh~p
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TO THE STATE ANO COUNTY TAX ASSESSOR. 261363 '
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Sl. LUCIE COUNTY, FLORIDA: '
This is my declaralion of Oomicile and Citiienship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Sectio~ ?22.17, Florida Statutes. '
1 was formerl a le al ~esident of . SA ~~s'
Y g (City) (State) t
and 1 resided at 1,~1.s~ 1-.I~ T ~ . However I have changed my domiCile
- (Street and Number) ~
to and am and have been a bona fide ~esident of the State of Florida since S~~'!~Y~ day of
~ , 19_Z3 and I ~eside ~et ' ~~/D ~N J v i ~j ~'g ~v'G
- (Street and Number)
' . _ ~,~T S~
FORT PIERCE, SAINT LUCIE COUNTY, FLORiDA ~vC- ~R ~j~'r/~S"'d
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(I~sert here any pertinenf facts,. suth as sale of properiy or business, or r~elinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.) • ~ ~
Applying, for Homestead ~ -
- Entering children in school :
~v/LOi/yG ~di~7/I //Y ~R7 /7 tJt.~ ~ . .
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e . i.'NCIE
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' /~/l j~~ ~ . tIfRII C~RC~~pO~t
~ / ,9 ~c ,y/L ~~F aECORO VERIftEp~.~
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5 _ 26~363
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1 FURTHER CERTIFlf that I will comply with all other requirements of a legal resident of ihis State. ~
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1 FURTHER CERTIFY that I have no intention to ret~rn to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~ ~a`~~ a~ ~ Sc~i le~r~
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~
• (Name)
~ ~.~0.L'~ COG•• , .
~ •tJ • ~*i ~G~~1 i` ~~~e ,LA.~ ~~E~ ~_i~~t(/w.~-
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~ - • _ ' = ~ ~ _ _ _ . " (Address) .
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~ ,~ujiscribed before me this ~ day of . , 19LL~
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....,r,~~i~v . , -
ROGER POITRAS
~ CLERK CIRCUIT COURT / ~ Notary Public
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~ !3y _ O.C. My Commissian cxpires
~ (To be oxocuted in duplicate and ori~inal filed ~vith Clerk Circuit CouH, and duplicato with ?ax Auossor.)
BCOK217 ~~1571 -
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