HomeMy WebLinkAbout1044 D~cla~ation of Domiail~ ~nd Chisenship -
15~~``~ . 9
TO THE STATE AND COUNTY TAX ASSESSOR,
Si. IUCIE COUNTY, FIORIDA;
, This is my decla~ation of Oomicile and Citizenship in ths State of Florida that I am filin~ this day in aooordana and
in oonformity with Chapter 222, Section 222.17, Florida Statuta.
I was formerly a leyal resident of p~ nviet~ I.ong Ialand ~1r y~~
(City~ (Stab)
end I resided at . However 1 have chsrp~d my domidle
(Sn~tt and Numbs~)
ro and sm and have been a bona fide r~ident of the Stste of florida :inoe i5~? day of
Novemdber , 19 66 , and 1 roside at 865 ~iraa• Blvd~ Port ~~Lnni w
,
(Street a~d Number) '
FORT rIERCE, S~AINT LUCIE COUNTY, !'LORIDA
and this statement is to be tsken as my declaration of dtiunship, actual leyal residenoe and domic.~le in th~ Stats of Horids.
pnsen here any pertinent fscts, such a: saie of property or business, or relinquishment of employm~nt -
at former domicile, removal of family to new domicile, purthsse of home, etc.)
i
Establia reaidence F~~~ AND RECpRpEp ~
~8 8T. LUCiE COIIN'h~ F'~,~.
~CORB VER1FlFO
~ 15219~.~
~st ~uy 2s a~ io : 3 T
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1 FURTHER CERTIFY thet 1 wili oomply with all oth~ roquirements of a(e~al resident of this Stafe.
I.f,l~N~yR. C~RTIFY that 1 have no intention to retum to my former domiCile, and i intend to remain in FORT
.i~r .
PIERCE~.
~`t~BrT` (j~~l@~~JNTY, FLORIDA, permanentiy. ~
- =ti~ i,~ ~ 7 `i~ ~
~~~j~'_:__~ i[~`'.~I. ~ '
.J ~ ' ~
• -y~i'_t~. O'~% % ~
'~}i"',~= (Name) -
, ~ - `4I C~;. ~ : . $~il Lansendorfer
~ ~ .
_ ;'~~r
l~C~~.... ~G~,J .`~tti` `
."-'';'r'r..:.~~:_"``'', Ferdinand ~~nQOrfer
. ~ i
Sworn to and wbscribed before me this 26~ day of J~~? . 19~- i
- ROGiR rORRAS .
- C~~jCpWtT Notary Publk
gy D.C. My Commisiwn expires
(Te b~ ~uarl~d in dupiie~ts a~ei oriainal fil~d with Cl~lc Cie~a~it Cov~f, and duplie~t~ wHh Tax Assa~aa
~~164 ~1043 ~ -
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