HomeMy WebLinkAbout1293 D~claration o! Domicile and Citizsnship ~
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TO TH~ SiATE AND COU~ITY TAX ASSFSSOR,
Sl. IUCi[ COUNTY, FIORIDA
i his is my dec!aration of Domicile and Citizensh~p in the State of Florida that I am filing ihis day in acco~dance and
i
in conformitv w~ith Chapter 222, Section ?.22.17, Florida Siatutes.
! was farmerly a legal resiclent of ~`racusa Nex Yoiic
(City) (State) ;
and 1 resided at Rt .~gY _ Nowever I have changed my domiGile
(Street and Number)
to and am and have been a bona fide resident of the State of flor~da sir,ce ~h _ _ day of
pecember
. , and 1 reside at ~~07 ~'~'e I - - - -
(Street and Number)
FORT PIERCE, SAINT WCIE COUNTY, FLORIDA
and this state.~ient is to be taken as my deciaration of citizenship, actual legal residence and damici~e in the State of Fforida.
(In~ert 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 hame, etc.) ~
~ntering children in Jr hi.gh school and ~''lementar~ schaoY
FiL .AN RE~ Rg00K
'N._
- ~L.~'
- - ~ 9;~9
. r . : , ,65 ~ 3
; .
' . , 'i ~ ti ~ ~ . . ' - '
~ _ . - . _ ROG~~~ ~.,^,_'i~~ NTYRK
- ST. L~~tt COU ~
. , . FLOr~1DA z
, ~
r ! J
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F
I FURTHEi2 CERTIFY that ! will comply with all other requirements af a legal resident of this State.
I FURTHER CERTIFY that I have no intention to re!urn to my former domic,ile, and I intend ta remain in ~ORT
PIERCE, SAINT LUClE COU~ITY, FLORI~JA, permanently.
. . . " ~ " , ' -
_ ~=~i~_l-~~G~- _1:E~~~~ r
(Nam ) ~
Patrici.~ ~?nki~l ~
. - .
~
. (Address)
' ~wom to and subscribed before me this 13t~i day of __~~~ber _ 1 q-65
~ ROGER F'OITRAS _ _
RK CIRCUIT OURT Notary Publ~c
~ mmi s~ n ex ires _
~ - D.C. My Co s o p
s
; (To be executed in duplicate and original filed with Cierk Circuif Court, snd duplicate with Tax Assessor.)
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