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Declaration ot Domicil~ and Cttizenship
14335~
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FIORIDA:
This is my declaratio~ of Domicile and Citizenship in the State of Florida that 1 am filing this day in aaordanos and
in conformiy with Chapte~ 222, Section 222.17, Florida Statutes.
I was formerly a legat resident of Gre~t g111~ ~ BtBt~II Isldlla Yew Yort
(Ciy) (State)
46 Y1dls1'id 8p6~d ~Wever I have cha ed m domitile
and I resided at _ _ _ ~9 Y
(Street and Numbe~)
to and am and have been a bona fide resident of the State of Florida since ______._10 day of
. April 65 2502 S 14th 8traet
, 19 and I reside at
(Street and Number)
fORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(lnsert 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.)
. FIL~q~~~DEQ
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B~tablieh g
R~~"; ~-•~-t ~ CLERK
ST. LUCtE COU,'VTY,
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~ FLORIDa
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resideM;.6f:th~~ti~te:-±~ =1~-
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1 FURTHER CERTtFY that 1 have no intention to return to my former domicjle, and I:iMisr~9~Lp,~~i~in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
.
(Name)
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' Joseph Ottia~
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. . . - ~ : -;".;t 'j : 7 ssrch 66
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' 19
- ;~•.:`,,~~+~1•t~~(~.sl`ibscribed before me this day of . •
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- ' ROGER POITRAS
CLERK ClRCUR C Notary Public
gy D.C. My ~ommission expires
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_ (To b~ ~xscut~d in duplicaN snd orisinsl Fl~d with Cl~rk Circuit Court, and duplicat~ wHh Tax AsMS~or.)
_ ° R 140 52
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