HomeMy WebLinkAbout0332 151715
Declaratio~ ot Don~icils and Citise~shlp
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FlORIOA:
This is my declarotion of Oomicile and Citizenship in ths State of Ho~ida thst I am filin~ this dsy in aooordanw and
in oonformity with Chapter 222, Sectior? 222.17, Florida Staturos.
PITTSFORD ~ N. Y.
I wss formeriy a le9al resident of . _
~~ify) (Sta»)
and I rssicled at 109 Il~ashingtoD Rd. ~r„evef 1 have chan~ed my domkile
(Straet and Number)
to and am and hsve been a bona fide resident of the Staro of Florida since 16th ~y ~
June ~ 19 66 ~ e~ et 763 B. Prima Vista Blvd,
(Street and Numbai)
FORT M~C~, S/11N? LUCiE COUNTY, RORIDA .
and this statement is to be taken as my declarstion of citizsnship, actual legal retidenoe and domicile in ths State of Horida. ~
qnse~t here any pe~ti~~t 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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FILING FOR HOMESTBAD PURPOS.BS
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- F~~o RECOao~o •
81.RECCORD VERN
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' iiOvER f=017RAS
GLERK C1RCU17 COURT
! fURTHER CERTIFY that I will aompiy with ail othsr requirements of a le~al rosident of this State.
1 FURTHER CERTIFY that 1 have no intention to return to my former'domicjle,.and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~x=>: (Nan'~e)
_ STBPHBN H. NBISON
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. A subsaibed before me this 9th. day of ~anuar , 19 67 .
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I.~f~'~~r:~ ~V RT Notary Public
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gy D.C. My~ Commisiron expires
(To b~ ~x~artad n dupiicaN and orioinal fii~d wilh ~Iw~k Cirarit CouM, and dupK~ats-witM Tax Ass~or.)
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' ~~K164 ~ 33~.;
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