HomeMy WebLinkAbout0216
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Declarution o! Domicite and Citlzenship
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~ TO THE STATE AND COUNTY TAX ASSESSOR, -
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1 ST. lUC1E COUNTY, FtOR1~A:
' This is my declantion of Oomicile and Citizenship in ths St~te of Florida that 1 am filirq this day in aooordanos ~nd 1~
! in aonfo?miry with Chapter 222. Settion 222.17, Florida Statutes. ~S~
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1 was formerly a i~ei ~e~~r of ~ldwin, Lon6 Iel~nd l~ew YorY
r ~C~ty~ (State) i =t~
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! 41 Roekwood ll~enns 1
f ~nd 1 rosided at . However i have changed my dornk3le
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' ro and am and have besn a bona fide rosident of the Stat~ of Flaida since ~ dsy of
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; . DeoenDsr d8 aoute 8 Boz 5981, ~lcewood Perk
~ , 19 , and I reside at ~
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' RORT NERC~, SAINT LUCIE COUNTY, RORIDA .
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a~d this statement is to be taken as my declaration of citizsnship, actusl legal residenas and donnititq~~5fdttr
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j (Inse~t here any pe~tinent facts, such as sale of property or business, or reli~quishm~i~q+F;e~l ~;~r.~~3• : .
; : :"•~w :o' w•r~~ N::
st former domkile, romoval of famity ta new domicile, purchase of home, etc.) 5:~,~°
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~atablia,hing residene~ ~ . ~ ~
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REC a~D
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~eco~ 30~K
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1954 J~!i~ 20 PM 12: 08
' ROG~R P017RAS. CIERK ~ .
+ Sj. lUC1E COUNtY. FlOR10A
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- 1 FURTHER CERTIFY that 1 will regi:ter at my local sddmu whsn the ~egi:tratiom books reopen, and oomply witfi i. .
all other roqui~ements of a legal rosident of this State.
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1 FURTHER CERTIFY that I have no intenYwn to rotum to my forma? domkile, and I intend to remain in fORT
PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently. ,
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~S~ro~~ to sR~.,":'~ruf~lssd be~on m~ this 80 day ~~TaII11~~~ - 19 d4
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ROG~
IT Notary Publk
by ~.C. My Gommission expiros
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- (Te b~ ~onwNd iw d~rppcah aed ari~iwal Al~d wbb CM~k Clraiit Ceurf, and ~ whh Tnc A~as~era -
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