HomeMy WebLinkAbout1765 Declaration ot Domiclle and Citizenship j
i488~S
TO THE STATE AND COUNTY TAX ASSESSOR, '
Sl. LUCIE COUNTY, FLORI~A:
This is my declaration of Domicile and Citizenship in the State of Florida thai I am filing t~is day in acro~dance and
in conformity with Chapter 222, Section 222.17. Florida Statutes.
New York Citq ( Bronx N Y
I was formerly a legal ~esident of - -
(City) (Stab)
3425 Kingsbridge Ave. ~ . However I have chs ed m domicile
and I resided at ~9 Y
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since zOth_ day of
_ Se~tember ,~q66 , and I reside at 124 Lucero Drive Port St.Lucie
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Establishing residence •
f~~EO aao RECOROEp
ST. LUCI~ ~pUNTY~ F~q,
RE~Cp p VERtFIEO
, --9~~lPeY:e~
bs ~FP Zs ~ s: rs
1488Qg
riOuER POITRAS
' ~~ERK CIRCUIT COURT
i
i
I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
~
I FURTHER CERTIFY that I have no intention to retum to m~yforrrier`tl5miu~e, and I intend to remain in FORT
•,:;~s::}::;~. ~ ~
PIERC~;.SIJ?1!!~}7;~1C1~ COUNTY, FLORIDA, permanently. ~
~ ,\?.u _ . ~O;
•.y,l~,,~ . ~ X ~ ~
~ , v ~ ' L Adolf i~4~~4~n
~ ` ,
~i•';-~ .~t • .
C ~ (Address)
-
Swom to and subxribed before me this - 28th day of Sgntem •er , 19~_.
ROGER POITRAS
CIRCUIT COURT Notary Public
By °`"'L`''~" O.C. My Commission expires
(To be ~xecuted in duplicat~ and originsl filed with Cl~ic Grcuit Court, and duplicah with Tsx Ass~sso~.)
~i~ ~ ~z
_ ~ ~ ~ _ . ~ _ - - _ a_~
~
~q;,
: ~
f
~ =~:e~