HomeMy WebLinkAbout0708 ~ i
DeClaration ot Dort~ic~le and Citisenship ~
1 ~~~•~.)O
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORI~A:
This is my declaration of Oomicile and Citizenship in the State of Florida that 1 am filing this day in accordance a~d
in tonformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal res~denr of ___Scotch _Plains New .Tersey _
Kity) (State)
~
s
1060 raritan Road
and 1 ~esided at _ _ _ _ _ _ . _ _ . _ _ . However I have changed my domiCile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _ 1_-_ day of .
September 65 312 Granada Street, Beach
- 19 and I reside at
(Stree' and Number) ~
FORT PIERGE. SAINT LUCIE COUNTY, KORIDA
and this statement is to be taken as my detlaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facis, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
,
FILE AN EC ED :
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Establishing residence ROGEFZ .~~;;;r~,~, CLERK
ST. LUCIE COUNTY,
_ FLORIOA t
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~ ! FURTHER CERTIFY ihat I will comply with all other requirements of a leyal resident'o,~' ih(lr~8tat~•~ .
.
I FURTHER CERTIFY that I have no intention to return to my former domiule, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FIORIDA, pe~manently. ~ ~
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3 - ~ . 4 (Name)
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. ; _ La~or Szo~ak ~
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~ Sworn to and subscribed before me this $ day of ~rCb ~ ~q 66
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E ROGER POITRAS
~ K CIR IT COURt Notary Pubtic
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~ By ~ D.C. My Commission expires ~
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~ (To be ~xecuted in dupliwte and originat fited with Cierk Circuit Gourt, and dupliut~ with Tax Ass~s~or.)
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