HomeMy WebLinkAbout0869 s
Deciaratior~ of ibe9mi~i1~ and Citi~enship ~ ~
. ~ 1 ~1 ~:()5(}
. ~
TO THE STATE AND COUNTY TAX ASSESSOR,
~ i
i
Sl. IUCIE ~OUN1'Y, FLORIDA.: ~
This is m declaration of Domicile and Citizenship in the State of Florida that I am filing Ihis day in accordance and ~
Y
.
in conformity with Chapter 222, Section 222.17, Florida Statutes. ,
I was formerly a legal resident of Brooklyn _ Netiv York
_ _ - - - - - - - - -
(City) (State) ~
,
911~ Ridge Blvd ~
and i residzd oi . - - - _ . However I have changed my domiGile ~
(Street and Number) ~
15th_ da of ~
to and am and have been a bona fide resident of the State of Floricia since _ _ y ~
i
~
March , ~q__~5, and i reside ar _____..Stai_Raute, Jensen Beach ~
- - - - '
(Street and Number) ;
FOt~T PlER~E, SAINT tUCiE COUNTY, FLORIDA
and this statement is ta be taken as my declaration of citizenship, actual legal residence and domicile in ihe State of Florida.
(Insert here any pertinent facts, such as sale af property or business, or relinquishment of employment i
~ at former domicile, removal of family to new domicile, purchase of home, etc.) ~
Applying for homestead - ~
t
. ~
•~r~~~r
. tlll,j f~ {
- ~~DEL, t
~ - pp~. ~
, .
„
l ff'I ~ ~ l
~ ~ r ~tr,, ~Ck-s-ztf ~
: ~ , ~8 ,
' ''U~.;r c~~~~ ~
. `r.:~ . ; J~, ,
f~ . `h'f~.~~ 4 ,-:~r,~-T. ~K E
CGF;,~~; ~
. ~ ,
~i., ~
' . Y• ' ~
. • f ' ~
- , . . f
- I FURTHER CERTIFY that ~ will comply with all other requirements of a legal residet5t~of~tl~i~ 5ta1e.;;~.~ ;~.'•:t~~•' ~
S . ~ I . , . " ~
~~~..5 ~
j; t FURTHER CERTIFY that I have no intention to retum to my former domi~ile, and I infend tq .Ger~'?d~' ~f? FORT
,,:si`;'-~,' ~
~ •
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. . ~
. i
; _ ~ l ~ a~ ~~r~.~ :
_ . . . . ~ :
; ~ 1~~~~~~ ~
- . (Name) . ;
. ~ ~ ~ i
. ~ Wallace K MacLeod ;
ti ~J ~ ' " : ~ = Jli C ' - ~.~-lL- ~
~ -1"f. •<<,`` ~ ~ ~ ~dc(r,ess_L d
' ~ • ~ '~c1 r e 1?'lac eo ~
•C~~'~~,~` . ' !
. ~ C: ~i~` • ~
'lli~il~t'~ {
Sworn to and subscribed before me this 17th day of _ _,Janaur~r , 19 ~6 ;
- t
~
ROGER POITRAS ~
~LERK CIRCUIT COURT Notary Public t
, ~
.~C.t.~ ' ~
B~ ~ c:~ c~!_E C~. D.C. My Commission expires _ ~
;
(To be executed in duplicate and original fiied with Uerk Circuit Court, and duplicate with Tax A:sess~or.) ~
. ,
~
aoQK 136 2b~ ~