HomeMy WebLinkAbout0940 Declaratlon ot Domicile and Citizenship O
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TO THE STATE ANO COUNTY TAX ASSESSOR, ~~~~4~
51. lUC1E COUNTY, FIORIDA:
This is my declarotion of Oomicile and Citizenship i~ the State of Florida thst I am filin~ this day in staorda~oe and
in conformity with Chapte~ 222, Section ?22.17, Florida Statutes.
I was formerly a ieyai ~es~de~t of - .Mianea_polis _ Miaaesoti
tCiy) (State)
and 1 resided at ---_2819 Glenwood Avellue However 1 have changed my domic3le
(Street and Number)
to and am and have been a bona fide resident of the State of Florida s~nce - 9th day of
Noveober ,~9
6~, and I ~eside at 240 Aldea Street,Pt. St. Lucie,
F t. P ie r c e, (Strcet anci Number)
fORT PIERCE, SAINT lUC1E COUNTY, FLORIDA Fla.
and this statement is to be taken as my declarotion of citizenship, actual legal residence arx! domiciie in the State of Florida.
(Insert here any pertinent facts, such as sale of properry or business, or relinquishment of employment
at forme~ domicile, ~emoval of family to new domicile, purchase of home, etc.)
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HOMBSTBAD
Flls£~ AND RECORBOOK
IN__
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~,~i ROgT. ~U~1E ~O~N '
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I FURTHER CERTIFY that 1 will comply with all other requirements of a leyal resident of this State.
I FURTHER CERTIFY that I have no intention to retum to my for er miCile, and I intend o remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
- c e rron
~a~) Cla re nsky
~ 240 Aidea Street
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~ (Address)
~;,~'s;; Sworn. b and subscribed befo~e me this 14th day of 1NarCh ~q 66 ,
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: .q~•. ~UIT COURT Notary Public
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~ ~8~ ~ ` D.C. My Commiuion expi~es
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_ 3 t: in duplicat~ sne! orf~inal fil~d wifh C{~rlc Circuit Caref, and duplleat~ with Ta~c As~or.)
- . aoox140 33?
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