HomeMy WebLinkAbout0389 L1ecl~r~tton of Q~mi~il~ antl Citi~c~nship ~
TO TNE STATC AND CGJNTY TAX ASSESSOR,
.1_~~ 1. r ~`~3
Sl. IUCIE COUNTY, FLORIDA: ~~~r
This is my declaration of Domicife and Citizenship in the State of Florida that ! am filing this day in accordence and
;n conformity with ChaptPr 222, Section 222.1/, Florida Statutes.
I was formerly a legal resident of ....~~~ag_.~~Y___---
(City) - (Staie)
and i resided at 5~-~ F~2~T'~~t lq~'_------- . . H~wever I hav~ chang~ my domiCile
(Street and Number)
ro and am and have been a bona fide resident of the State of Florida since day of
M ay-- 19
b5---, and I reside at750 _ Airasa _Slvtl: P• S. L•
~ ~ (Street and Number) ^
FORT PIERCE, SAIPtT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizer.ship, actual lega! residence and domicile in the State of Florida.
(Insert here any periinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Establishing residenoa and app~ying for homeatead
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` 1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
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1 FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
t PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
f•,,;;'t4111i;!/f,: ~ __l---ec.~~ V\ ~e~~Z.~
~C~~; h (Name)
. ~ats on ~ C~ rl R
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: - - ; = 7 ~~~L:. C1 ~ yl ~r~
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' • . Ne31e w. Matsoa
` ~ ~ I~th January 6b
~'~~vYor~:tp~.a~ici subscribed before rne this day of - , 19 -
ROGER POITRAS
K CIRCUIT CO T Notary Public
N r~Ot~~c~
B ~u~ D.C. My Commission expires
(?o be executed in duplicate and eriginal filed with Glerk Cirtuit Court, and duplicate with Tax Assessor.)
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