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TQ TNE STATE ANO CAUNYIf TAX ASSESSOR. 14~j ,F'j0
Sl. lUC1E t_OUNTY, flORiOA:
This is my declaration of Oomfcile and Citizenship in the State of Florida that 1 am filing this day in aaordt~nte and
~n conformity with Chapter ?22. Sectio~ 224.17, Florida Statutes.
Westwood.. New Jersey _
I was formerly a legal resident of -
(City) (State)
and 1 ~esided at _______349 j~~evet.te Ave. However I have changed my domitile ~
(Street and Number) .
to a~d am and have been a bana fide resident of the State of Florida since -__1,~.*~--_--- day of ;
212 W Arbor Ave Rv P r ~
--~1a~C - - - 19~if~. and I reside at -s ~
, (Street an~ Number)
FORT PIERGE. SAINT LUCIE COUNTY, RORIOA - _
and this statement is to be taken as my declaratio~ of ciYszenship, actual legal residence and domicile in the State of Horida.
(Insert here any pertinent fads, such as sale of prope~ty or business, o~ relinquishment of employment
at #ormer domicile, removal of ~amity to new domicile, purchase of home, etc.)
Establishing resid~nce,
p A~p RECOR~E~ s
s
~ C~E COi3N?Y. F~• '
RECORO VER'.FIED
P~ Z'31 ~
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14~sso
~j ,.O~E~ '~~~j ~oURT :
j ~~ERK ~~RCUtT _ i
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I Fl1RTHER CERTIFY that 1 will comply with all other requirement~ of a lega) resident of this State. s
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~ I FURTHER CERTIFY that ! have no intention to return to my former cl~mitile, and I intend to remain in FORT ~
PIERCE, SAIPfT LUCIE COUNTY, FLORiDA, permanently. ~ ~
_ 1T' ~
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: - , Kurt H. ~'n~ast
;l • ~ i= . r - - 1
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~ ..Sworn.to•an~ subscribed before me this . 3rd day of November , ~q 6(~
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~ ltOC ER POITRAS
CLERK CIRCUI~COURT ~Jotary Putsiic
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~ g - D.C. My Commission expires
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~ (To be execuled in duplic~M and original filed with Gerk Grcvit Court, aieei duplicst~ with Tax Assassor.)
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