HomeMy WebLinkAbout0371
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m ile and Citizenshi ~ ~
De~laration ot Do iC P ~
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TO THE STATE AND COUN7Y TAX ASSESSOR, 1 UfI CjI D~
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Sl. IUCiE C~UNTY, FLORIDA~
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~ This•is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
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in confo?mity with Cha~pter 222, Section 222.17, Florida 5tatutes.
1
Teanetk He~ Jersey
? I was formerly a legal resident of _ . ~
(City) . _ _ .
~tate)
a
and 1 resided at _ 803 C011~1b1i3__Di~rQ However 1 have changed my domic.ile
_ _
a (Street and Number)
y
I
to a~d am and have been a bona fide resident ~f ~he State of Florida since 13 day of
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t.
401 Tran~uillA Avenne •
= •lu~~ - , 19~_ __65and I reside at - -
(Street and Number~
fORT PIERCE, 5AiN? LUCIE COUNTY, FLORIDA
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and this statement is to be taken as my dezlaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or reiinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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I Batablishing residrn+ce ,
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! ` ~ `f , •••••f ;i
~ E~ttring Son in 8th Grade Ricky Sil'erstein y_ 4;,:~
" d$nghter i~ lOth Grade L.nda Silverstein '--~0 -
" de~~hter in I2th Grade I~[yra Sil~?er~tein Y; • r'~
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F~O~~~~U~yTy RK
I FURTHER CERTIFY that I will comply with ail other requirements of a legal resident of this 51ate.
I FURTHER CERTIFY that ! have no intention to refiurn to my former domic,ile, and I intend to remain in FORT
PlERCE, SAINT LUCiE COUNTY, FLORIDA, permanently.
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, . • (Name)
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; ~ ~ ~ Herb Silverstein -
a : - + -
~ . . - ' V (Address)
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v~~~vo~fca and subscribed before me this 27_ day of -___~_____Ju ly _ ~ 19 65
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! ROGER POITRAS - -
LERK CI IT COURT Notary Public
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By D.C. My Commission expires
(To be ~x~cut~d in duplicate a~d original tiled with Clerlc Circuit Court, and dupliuts with Tax Assessor.)
BQa~ ~2~ 36~ ~
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