HomeMy WebLinkAbout0664 D~ciar~ation ot Oomlaiio ~d C~tlsen~hip
t0 THE STATE AND COUNT1f TAX ASSESSOR. ~
Sl. IUCIE COUNTY. FtOitIDA: ~
This is my dctlarotio~ of Domicile and Citizenship in the State of Flo~ida that 1 am filinc~ this day in aoeo~dance and
~n cor~formity with Chapter 222, Section 222.17. Florida Statutes.
New Jerse
1 was forme~ly a legal res~denr of _Cranford _ Y _
(Ciry) . (State)
and 1 resided at _____1L ~~~.PS p18C~ However 1 hsve changed my domitile
(Streat and Number) -
to and am and have been a bona fid~ ~esident of the State of Florida since lst _ day of
_~~~rch , 19 66 242? Atlantic Beach Blvd.
, and I reside et _
(Street and Number)
FORT PIERtE, S.41NT~ LUCIE COUNTY, FLQRIDA
and this stateirr.ent is to be taken as my declaration oF citizenship, adual legal residence and damicile in the State af Florida. E
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(Insert here any pertinent fads, such as sale .of properry or 6usiness, or relinquishme~t of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Establi.shing residence _
;
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~ F11.E0 AND RECORDEO ~
31: LUCIE CQVAJTY. FLA. }
~EGORD VEAIFIEp ~
'G6 NpV E p s~~,~'~
4~9~`~'3S .
~ _ ROGER r01TR4S ~
GLERK CIRCUIT COURT -
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I RIRTHER CERTIr1f that 1 will aar.ply with al! other requirements of a lega) resident of this State. .
1 FURZFIER CERTIFY that I have no intention to retum t y for er domiGile, and t" tend to remain in FORT
PiERCE, SAINT LUGE COUNTY, FLORIDA, permanentiy.
~ s~t?~t"~~i ~ ~ • ~
,.•_`t j=~~ : ^ ~ =n~i ; ,t-
(Name)
- ~ Jotn F. Gree~
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= ~ (Address)
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• ;......--a - 14tr.
~ ~Vvo~n to and subsuibed before me ihis day of November , ~q 66
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ROdER POITRAS
CtERK CIRZ~URT Notary Public
~t-c~i .1.~
gy D.C. My ~ommission expires
(To b~ ucecuted in duplicst~ aRd ori~insl filed with ~1 ~ c rcuit Ca+rt, snd duplecah witl~ Tax Ass~ssor.)
- so~ ~59 ~E 64
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