HomeMy WebLinkAbout1131 Declaration ot Domicile and Citizenship D
143641
TO THE STATE AND COUNTY TAX ASSESSOR,
51. IUCIE COUNTY, FIORIDA:
This is my detlaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in acoordante and
in conformiry with Chapter 222, Section 222.17, Florida Statutes.
New Jersey
1 was formerly a legal resident of ___SwE@de~h11t0-__ -
(City) (State)
and I resided at R~--~__-BQX14~L_- However 1 have changed my domitile
(St~eet and Number)
to and am and have been a bona fide resident of the State of Florida since ____.______8tb day of
~E~l6~X Oc t 6 S
, 19
~x, and I ~eside at ~00 Seaway Driv
(Street and Number)
FORT PIERCE, SAIN? LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert he~e any pertinent facts, such as sale of property or business, or ~elinquishment ot employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Establishing residence
N aE~°R
F~
~N_. Q~ 12 ; 02
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~ . , ,66 ~p1t 1~3~~ 1~RK .
' ~ ; ~~taS~NTY.
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'''~'~URTHER CERTIFY that I will comply with all other ~equirements of a lega) resident of this State.
I FURTHER CERTIFY that 1 have no intention to retum to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~~;;:s?ni:;::;;.~
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= ' i1~ ~c~'; (Name)
r._{',~ = Charles F. rover Sr.
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Sworn to and~~subscribed before me this 17tb day of Mas~r..h , 19~~.
ROG POITRAS
CIRCUIT COtJgT Notary Public
y
ey D.C. My Commission expires
Qo b~ uaeut~d in duplicah and ori~inal fil~d with d~ek Graiit Cour~, and duplicat~ wifb Tax Aa~stor.)
~ 600K
~ ° ~ 140 528
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