HomeMy WebLinkAbout2771 Declaration ot Domicile a~d Citize~ship ~
~ 14`7596
TO THE STATE AND COUNTY TAX ASSESSOR,
Si. LUCIE COUNTY, FIORIDA:
This`is my declaration of Domicile ar~d Citizenship in the State of Fl~rida that t am filing this day in accordance and '
in conformiy with Chapter 222, Section 222.17, Florida Statutes. !
i
N~ Yoric `
I was fo~merly a legat resident of ~t~ - ,
(City) (Stab)
:
and 1 resided at __~52 Ialand R3. However I have changed my domi4le
(Street and Number)
to and am and have been a bona fide resident of the State ot Florida since .
~ day of
~uguat 9809 So. Ind. River Drive ~
, 19
66 , and I reside at ~ ~
(Street a~d Number) ~
FORT MHtCE, SAINT LUCIE COUNTY, ROftIDA f
and this statement is to be taken as my declaration of citizenship, actual 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.) ~
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IDitering ehildren in School FILED AND REEORDEA
sT• LUCIE COUN7'Y ~ f
Naaay He~anna 12 yre old RECORD VERIFtEO~'
Peter Hermanna 12 yrs olQ JJ?,~/
daaet Hermanua 10 pra old ~ `"~P
Wa].ter xe~anns 7 yra old ~s AUC ! D PM I 1
14'~ ~
5~ 4
~:'GGEF r~01TP,,~S ~
CLERK CIRCUIT COURT
i
1 FURTHER ~HtTIFY that I will comply with all other requirements of a legal resident of this State. r
. :
1 FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT ;
~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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J `;rL ` (Name)Ed1~at'd HeY7natlri8 i
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.V J ~'c'' '
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• `a ~ (i'•. ' i
r~.:.. ~ t'v': y. ~ 9809 s. Indian Ri~er Driv~e, Ft.Pierce,' Fls• ~
z ~ : • ~ '='f N~ = . _ (Address)
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~.''•••S~wesit~ te,~f?ut-subscribed before me this 1~ day of ~~St , 19~ .
' ~~i, `~C ~ z G
~~'~~jr, i~w~e'•`• ~
ROC~ER POITRAS f
~LERK CIRCUIT C RT Notary Public ~
. ~
By D.C. My Commission expires .
;
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(To b~ ~xscut~d in dupliuts and ori~inal filed with Cl~rlc C'irarit Court, and dupliut~ with Tax Ass~ssor.)
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