HomeMy WebLinkAbout1569 Declaration of Domici!e and Citlzenship J"'~
TO THE STATE AND COUNTY TAX ASS~SSOR, 1.3:~"731
51. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in atcordance and
in conformity with Chapter ?22, Section 222.17, Florida Statutes. .
1 was formerly a legal resident of _ . Nea_ York Cit~r _ New Yort
(City) - (State)
1660 Crotona Park Bast 'Bronx 60
and I resided at _ _ _ _ _ _ . _ _ .t_ _ _ . However I have changed my domiCile
(Straret and Number)
to and am and have been a bona fide resident of the State of Flarida since 22 _ _ day of
~g INay 65 25Q3 Bertha Avenue
_ 19_- , and I resicle at
(Street and Number)
FOltT PiERCE, 5AINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration ot citizenship, act~al legal residence and domicils in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile: purchase of home, etc.)
~ FILEQ„~Np ~~p~~D
_ ,Vl'ltti~ E~
&stzblishing residence K
'ss ~r~ 2s ~a ~3'~'~`u1
1~OG~`r? Pi?~7i;~:,S. CLERK ~
~r• LUCIE CCUNTY,
F~ORtDA
~ .
,~r~
i ,
..s : . _ _
" ~ ~ : • `
I FURTHER CERTIFY that i will cnmply with all other requirements of a legal resident of tii~_Sts~:::•~t;1•.'-~. ~
I FURTHER CERTIFY that I have no intention to return to my former domi~ile, d I intend~to remain in FORT
PIERCE, SAIRJT LUCIE GOUNTY, FLORIDA, permanently. ,:~~~j-l~ ~
~ (Name)
.
~ . . _ ~ ; . Puk2i~S ~ Ernest
~
_ ~ (Address)
~ `~±~~~w
,:r ~ 65
- , .
.:~9worn to and subscribed before me this - 25 day of ~tober , t9
ROGER POITRAS
K CIR IT COURT Notary Public
By ~ , D.C. My Commission expires
(To b~ ~xec~ted i~ duplicate and n~ginal ~ilea with Gerk Circuit Co~rt, snd dupliuh with Tax Ass~s~or.)
g~oK129 3D~~