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DQCfaration of Domicile and Citizer~sj~ip
TO THE STATE AND COUNTY TAX ASSESSOR. ~c~S~c
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51. WCIE COUNTY, ~IORIDA:
This is my declaration of Domicile and Citizenship in the State of Flo~ida that 1 am fili~g this day in actordance and
in contormity with Chapte~ 222, Section 2~2.17, Florida Statutes.
1 was fomnerly a legal ~esident of i'DAl LL',1 ~~d
(City) (State)
and I resided at _ i~~~J~Slj ~ l~e . , However 1 have changed my domit+le
~ (Sfreet and Number) •
to a~d am a~d have been a bo~a fide reside~t of the State af Florida since ~q~ day of
, 19..Z~, and t reside ~at ' ~ ~J~' ~
(Street and Number)
~
FORT PIERCE, SAINT LUCIE COUNTY, FtORIDA ~
and this statement is to be taken as my declaration of citi2enship, actuat fegal residence and domicile in the State of Florida.
(Insert here any pertinent facts,. such as sale of property or business, or relinquishme~t of employment
at former domicite, ~emoval of family to new domicile, purchase of home, etc.) ~ ;
Applying, for Homestead ~ _ _
- J Entering children in school ;
~~t~~A ~ue L ~S~dN •
.S~o%/ homc jAl QniO~ h~l~a~c~~shed ..em~1o~~MenJ~'fGZ~vd -
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~ 1 FUR7HER CERTIFY lhat I wil) comply with al) other requirements of a(egal resident of this State.
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~ I FURTNER CERTIFY that f have no intention to return to my forrner domi~ile, and 1 intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, pe~manently. ~
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1. CO.,~ .
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' Swomtto and subscribed before me this --2- day of , ~q..~~ ~
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~ ROGER POtTRAS
~ Cl.~RK CIRCUIT COURT Notary Public
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~ dY D.C. My Commission expires
' eooK 217 Mc~2238
(to be oxecuted in duplicate and ori~ina) fileJ with Clerk Circuit Court, and d~plicato with Tax Assossor.)
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