HomeMy WebLinkAbout0613Dtclaratior- of I~omieile ana citizenship
` To THE STATE ArrD oocrN•rY TAx AsseasoR,
`-~'T. LUCIE COUNTY, FLORIDA:
d~k 49 P~fi613
ST. ~U~IE %~UNTT. ~ L.4.
This is my declaration of DOmiclle and Citizenship !n the State o[ Florida that I am filing this day in accordance
and in conformity with Chapter 222, Section 222.17, Florida Statutes.
Canistota New York
I was formerly u Legal resident of --- _
• ((qty] State
and I resided at X08 dew A08 tOn street However, I have changed my domicile
(Street and Number]
to and am and have been a borsa fld~ resident of the State of Florida since ~Cth day a!
November
1s 62 and I reside at 523 50 4th Street
(Street and Number]
E`ORT PIERCE, SAINT LUCIE COUNTY. FLORIDA,
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
[Insert here any pertinent facts, scch as ssle of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile. purchase of home, etc•]
Erl::ering riona ~[usacchio in the 9th grade
1..1 O~i6
.p~p~RECpRQ~00K
~~c
IN
_ 196x NOV ~ 3 aM ~~: 32
r'` `'' ' S, CLERK
..~ ;;cl)~ ~ :V ROGER pplTftA
LU jY, f LORIO A
rn
a ,
I FURTHER CERTIFY that I will rebister at my local address when the registration b~oks reopen, and comply
with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return .to my former domicile, and I intend to remain in
FORT P~ SAI1V'1' :,UCIE COUNTY, FLORIDA, permanently. ----.,
!~ ; ~; _ ,
t,~ r
' ', '`• ~ A17.an SYeIi ore](Stepfather)
v' '1
~ - -
~ ~
~. - - ~ v [Address]
o,,•••.......• nth November
Swbrji t6 pnd`,s~lisnribed beforr me rhi~ _._-fay of 19-~
• ROfJER POITItAS --- - -- --- •
LERK CIRC IT COURT T?otary Public
--~ D.C, hiy Commission expires___
[To be executed In duplicate and origi~sl filed with C[erk CIrcuit Court, and duplicate with Tax Assessor]