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Dealaration of Do~nicile a~d Citize~ship
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TO THt StATE AND COUNTY TAX ASSESSOR, 'r `
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51. LUCIE COUNTY: FIORIDA: ~
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T~~is is my declaration of Damicile and C+t.izenship in the State ot Florida that I am filing this day in accordance and ~E
tonformity with Chapte- 222, Section 222.17, Florida Statutes.
I was formerly a lec~al ~es~denr or Queens_ ~=ounty_ _ New York ~
~~;ty~ (State) ~
nnd I resided at . 24311 _ 129 _ Ave_. ROSed81~ _ However I have changed my domic,ile !
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(Street and Number)
to and am and have been a bona fide resident of the State of Florida since 2Q~~_ day ot ~
-~ril _ , 19__ E~4, and I reside at __~?~7_.~~4I113t AvC. ~
(Street and Number)
FORt PIERCE, SAINT IUCIE COUNTY, PLORIDA '
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and ihis statement is to bE taken as my detlaration of citizenship, actual legal residence and damicile in the State of F!orida. j ~
(Insert here any pertinent facts, such as sale nf property or business, or relinquishmeni of employmert ~ ~
at former ciomicile, removal of family to new domicile, purchase of home, etc.) ~
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Bste~blishing residency ~~~E ~
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( FUR7HER CERTIFY that ! will comply with ail other requirements of a legal resident of this State. '
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I FURTHER CERiIFY thai ~ have no intention to retum to my former domiGile, ~nd I intend to remain in FORT !
PIERCE, SAINT lUC1E COUNTY, FLORIDA, permar.ently. ~
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• . . ~~li l.~i i
_ . (Name) ~
,y"_ Louis Alexander '
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';y - . .:'Y #:s, ;i` ' ~ {Address) ~
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~ ~ ~ ~ 23rd Augast r
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~~wom to and subscribed before n~e this day of , 1q6~ . ~
ROGER POITRAS ~
K C~itC~JiT URT Notary Public I
_ D.C. My Commission expires - '
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(To bs exscuta~ in dupiitate and original tiled with Clerk Cirwit Court, and dup{iuh with Tax Assessor.) ~
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