HomeMy WebLinkAbout0447 ,
, r..,.
~eclarafcion ~t Dc~r~iciie an~e V~~~zeng~yi~ ~
TC~ TN[ STATE AND COUNTY TAX ASSESSOR, f~
5~ .~_lli:lE ~UUfV i Y, rluKit~fa:
ihis is ~yry declaration of Domicile ~nd ~itizenship in !he State of Fiori-ia that I am filing This day in accordance and
in conformity with Chapter 222, Secfion 222.17, Florida Statutes.
I v~as formerly a ~egal resident of . LOUIVILI.B Ky
(Gty) (State)
a ~ T • • ' ' _ T _ ~ ~ ;
/ J 1J SSUCIIUCi t y a..atlc
and 1 resided at - - - - - . However t have changed my domiGile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ~'S t_ day of
~farch 6S ?16 E1 Rancho Dr.
- 19_--- , and I reside at
(Street and Num~aer)
FORT FIERCE, SAINT IUCIE C~UNTY, FLORiDA =
anc~ this statsment is to be taken as my declaration of citizenship, actual iegat residence and domicile in the State of Florida.
(Insert here any pert~nent facts, such as sale of property or business, ar relinquishment of employment
at formsr domicile, removal of family to nev~ domicile, purchase of home, etc.) ~
~
~
FILING rOR HO~tESTEAD PURPOSBS
i
E~ RDED
~ . AN~r~~--~~~K
: . ; . . ~
~ : ~ - - ~ pµ 10 ~ ~3 1
. ~a~~ ~~,p~;~~; ~
r . _ . - ~`-L _ , t; L~ ccK
! . _ . _ ~ . ouL::, c:+~ ~~~o~ra-~Y.
t . , R ~-V LpR1pA
~ , ~ I
~ ~ ~
. . ~
I FURTHER CERTIFY fhat I wiU comply with all otfier requirements of a legal resident of this State. ~
I
I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
PtERCE, SAINT LUC~E COUNTY, FLORlDA, permanently. ~
~ _
; ~ ~
•:r:r . . ~-~.1~f ~
. • : ? ~ :y" Y . (Name) ~
'J GOG , ERNEST L. BEELfiR
:`r + f.
• i
' ~~i ~ ' - _
' . . c.: 3' _ ' (Address)
~ • r;~.
-
1 . ' ~ ; `
~ ,5wartr''t6 a?id subscr;bed before me tnis 6th day of anuar~ ~ ~q 66 ,
~ ~'c~~~ r r. •
~ ~ ~
~ ROGER pAl
~ CLERK CIRC T OURT Notary Public
.
; BY - D.C. My Commission expires
!
{
~ ,
~
; (To be exewted duplicate and original fileci with Clerk Circuit Court, and dupliwte with Tax Assessor.) ~
t
; F~RK:i3~ 447 ~