HomeMy WebLinkAbout0184 ~ . . ,
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~ Declaratian ot D~a?mlcit• a~d Citizenship
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TO THE 5TATE AMD COUNTY TAX A55ESSOR,
~ Sl. lUC1E COUNTY, FLORIDA: ,
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~ This `ii my detlaration of Dvmicil~ and Citizenship in thc State of Fto~ida that I am filing this day in accordance and
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im m~formity with Chapter 222, Section 222.17, florida Stetutes.
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I was formerly a legal res~denr of _ Ntw Yort Cit~ N'~ _
(City) (State)
' and 1 resided et _ 180 *_BiSt B1'ld ~r~.~_,~ However 1 havt changed my domiule
(Street and Number)
s to and am and have been a bona fide resident of the State of Florida since _ lst day of
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1T , 19
65 and I reside at _~Q$_QY!-thI-Q~Q~-~L-p-~-r~--Ct.Lus i~t
(Street and Numb~cr)
{ t~ORT PtERCE, SAlt~IT LUCIE COUNTY, FLORtDA
ar?d this statement is to be taken as my declaration of citizenship, actual legal residence and domicife in the State of Florida.
(tnsert here any pertinent facts, such as sale of praperty or business, or relinquishment of employment
. at former damicile, removal of family to new domicile, purchase of home, etc.)
Bstablishing residen~q ,y1L~p q~0 R~~Q~O~o
BpOK
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~ '65 JUr 23 PM 2: ~q
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: N:~K . ~ - . ~QS~R ~'pt~['r~~45. CL~
_ ~ ~ ~ . ~.U,6{~' COUMTY R~
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- 1 FLlRTNER CHtT1FY that 1 will camply with all other requirements of a le9al resident of this 5tate.
I FURTHER CERTIFY that I have nc intention to return to my former domi4i~e, and I intend to remain in FORT
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PIERCE, SAINT LUCIE ~OUNTY, FIORIDA, permenently.
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Sworn t~nd substribed before me this 23r~ day of .--~til.~Z , 19_~S
RQtiER POCfRAS _
' /~LERK CIRCUtT OURT Notary Pub4ic .
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~ i.C. My C~mmissi~n ex~ires
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CTo b~ ~x~rcuMd in d~plicats and origina) ~ile~;v~ Greuit Couef, and duptitsh with Tsx Ast~ssor.) Y
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