HomeMy WebLinkAbout0397 Declaration ot Don~icile a~d Citizenship ~
TO THE STATE AND COUNTY TAX ASSESSOR, 143i~7
Sl. LUCIE COUNTY, ~IORIDA:
This is my declaration of Domicile and Citizenship in the State of Ftorida that I am-fili~g this day in aaordance and
in co~formity with Chapter Z22, Section 222.17, Florida Statutes. .
Island New York
I was formerly a legal ~esident of ____~n$_
(Ciry) ~ (State)
and I resided at 2463 _HOrSCE COurt Ho",iever I have changed my domitile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since l5ttl___ day Qf
_Jd~ ~~9 65and I reside at Rt 2 BOx 380-
(Street and Number)
FORT PIERCE, SAINT lUG1E COUNTY, RORI~A
and this statement is to be taken as my declarotion of citizenship, adual legal residence and domicile in the State of Horida.
(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.)
, Applying for homestead
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r , . ~ . FILED AND RECOROED
~~:;;;=c,1y;:...,L'OG!;~ Ih~_ 900K
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!~~''••......::•'~Yv1'' ROGEn FJs~R.~S. CLERK ~
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~~•~t,:,:,::~`'' FLORIDA
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1 FURTHER CERTIFY that I will comply with all other requirementa of a leya) resident of this Stafe.
I FURTHER CERTIFY that 1 have no intention to return to my former domitile, a~d I intend to remain in FORT
PtERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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.'`c;,;.,+ (Name) l
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c~.~. ~ l~~ ` Henr O Berger
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~ y~,cri~i ~~~~?l~uribed before me this lst day of ~'1arCh , ~q 66
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ROGER POITRAS
CIRCUR COURT Notary Public
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~ By D.C. My Commiuion expires
. Ro b~ ~x~culsd in dupliuh and orisinal fil~d witb Cbric Circuit Court, ~nd duplica» with Tau Aaa~or.)
~oK139 394
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