HomeMy WebLinkAbout0393 DeciAration ot Domicile and Cittzenship 15l'7~
TO THE STATE AND COUNTY TAX ASSESSOR, ~
Si. lUC1E COUNTY, FLORIDA:
This ia my declaration of Domicile and Citi:enship in ths State of Florida that 1 am filiny this day in accordanos a~d
in oonformity with Chapter 2ZZ. Section 222.17, Flo~ida Statutes.
Ocean Grove New Jersey
I was formerly a leyal resident of
~~;y~ (Statr)
and I residad at _ 103 Lake Ave . . However 1 have chanqed my domic~le
~ " (Strset and Number)
to a~d am and have been a bona fide resident of the State of Florida since 28th day of
Oc tober ~ 19 6b~ a~ ~ r~ide at 103 Ridge place
(Street and Number)
FORT NERCE, S~AINT WCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, attual legal residenoe and domitile in fhe State of Florida.
pnsert here any pe~tinent facts, such as sale of property or bu:iness, or relinquishment of employment
at former domicile, removal of family to ~ew domicile, purchsse of home, etc.)
. Bstabiishing residence and will apply for homestead
FILED ANO RECp ~
" S1'. LUCIE COUNTY. ~ ~ ~
RECORO VERIFIED
'6l JA
510
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AM I I : 00
;
ROG~R ~OtTRA3 s
CLERK CIRCUIT COURT
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1 R1RTFlER ~ERTIFY tfiat I will oomply with all other requTrem~nfs of a lepal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SA~~VT:,LUCIE COUNTY, FLORIDA, permanentiy_ ~
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~.''.-r•••. - - LOUIS B ~IIHAt]i]
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Swom'}o and subsuibed before m~this lOth day of _ JanLar~ ,~q_b,7
ROGEI[ POITRAS
CIRCU COURT Notary Public
gy D.C. My Gommiuion expi~es
(To b~ ~x~whd in duplicaf~ and oeiQinal f~l~d wiM~ CIKIc Circuit Cov~t, and duptieah.with Tax A~or.)
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a~K 16~ ~ 391 ~
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