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Declaration of Domicile and Citizenship
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20 PAcrB22
TO THE STATE AND COUNTY TAX ASSESSOR,
St. Lucie
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_COUNTY, FLORIDA:
This is my declaration of Domicile and Citb:enship ill 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 formerly a legal resident \)f _ _ Buffalo
New York
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(Clrr)
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and I resided at _ _ _ o}43~_!!!~~~!"~ _~~_~!~__~_~V~_.___._
(Sir,", end Number) -
However, I have changed my domicile
to and em and have been a bona fide resident of the State of Florida since_
6
. day of
October
_ , 19 _~l , and I re1ide at _ _. _ ~l~~. _ ~7~.h_~_~~~_e~
(Street aNt Number)
Fo~t~1erce.
. _________' _ _. __ __ ____S_t. __L\1c1e__
_ County, Florida,
(City)
and this statement is to be taken as my deeleratlon of citizenship, actual legal residence and domicile in the State
of Florida.
(InMrt .... My pertlnen! '1lCtI, auch .. .... of JWOPW1Y cw buelnfta, or ,.11nqulshnent of ~"*'t .. fonner domlci",
_.1 of femlly 10 _ domldl., purch.e of ,*,,-, etc.) _
Applying for homestead
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~~/LED AND RtCORDED
IN JICIII D__ ~
-'~BOOK
196; OCT' 9 PIf',:
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I FURTHER CERTIFY that I will register at my local address when the registration boob reopen, and comply with
all other requirements of a legal resident of thl, Sta".
I FURTHER CERTIFY thet I have no intention to return to my former domicile, and I Intend to remain in______
_ ____ __ _____ __F..o~~_p-~,.T-C;'________ _ _____ _ .
(CIty)
---- ------______ __~_~L_~~_~'~u~ -County, florida,
perrNnentty.
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Sworn to and wbscribed before me this_
_ _9_~~~.i!t_ !!_Q~~~~~C!!_ __ _____ __.__
(Adch.)
.~9_____ day of ____Q~_WM:r__________________, 19.91__
ROGER PO~, ClERK CIRCUIT COURT
By ___~-u_~-~---------- D.C.
Notary Public
\)
My Commission expires _____________. ____________.
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