HomeMy WebLinkAbout0108 i _ ~ _ _ ~ `
~ecl~~~tton ot Dor~icilp And Citizenship ~
TO TNE STATE ~ND COUNTY TAX ASSESSOR,
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Sl. LUCIE COUNTY, FIORIQA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerty a legal resident of ShlpBhe wana. Irid.
(City) (State)
and I resided at _ x~__ . . Ho~vever 1 have changed my domi~ile
(St~eet and N~mber)
to and am and have been a bona fide resident of the State of Florida since .___~s.t _____T_ day of
November t v__ _ ~ 5 and 1 reside at _7_64 _PY'~m8_Y~.s ta R1vci _ _
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA '
and this statement is to be taken as my declaration of citizensliip, actual legal residence anci domicile in the State of Florida.
(Insert here any pertinent facts, suc1~ as sale of property or business, or relinquishment of employment
at former domicile, remova! of family to new domicile, purcha:e of home, etc.)
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~ ~l ' ' `A~plying for homestead
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E : :~:~;'~`uy ~ ' '66 JAP~
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~''~~U~; _ c~~-'`,,;.:,.-~ ROGt1i PU; i~f?.'1S.
: . r,,;~r:?;t~~~,~~ . COUNTY,
~ ' ST. LUCIE ~LERK
s ~ FLOR~Da
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~ I FURTHER CERTIFY that I will comply with al! other requirements of a legal resident of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FOR7
,
PIERCE, SA(N~~~~G4E, COUNTY, FLORIDA, permanently. ,
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~ ~ . , .
~ _ C- ~1~•~'-: . ' -
~ ' ~ . , ~ ~ ~ (Name)
- ~_;:.~;T : seph S. Haines
- ;1 ' . . ~ ' :4 ' .
. - `~•t:H. • ' w_ -
~ . (Address)
,:,~J=,•:~ti~.~•,`
Sworn to and subscribed before me this ~7~h day of _ January ~ 19 ~6
R4GER POITRAS
RK CiRCUIT COURT Notary Public .
By . G~~c.-'~-~- ~ D.C. My Commission expires
(To be executed in duplicate and original fited with Clerk Circuit Court, and dupliwte with Tax Assessor.)
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