HomeMy WebLinkAbout2802 D~claratlon ot Domfcil~ a~d Cftiss~ship
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TO THE STATE AND COUNTY TAX ASSESSOR. ~15334i
St. lIJCIE COUNTY, FLGRIDA: ,
This i: my declsration of Domicile and Citizenship in the State of Florids th~t 1 am fliinq this day in aao~~d~~ and
in oonformiry with Chapter 222, Section 222,17, Florlda Statutes.
I was formerly a legal ~esidant of SUNGBY G.BRONG INDONESIA
t~itY) (Staf~)
and 1 resided at . However 1 hav~ chanqed my cbmitjl~
(Strest and Number)
ro and am and have been a bona fide resident of the State of Florida sinee lst day of
APRIL , 19 6S ~ a~ ~ 108 E. Prima Vista Blvd~ PT. PIBRCE, FLA
, (Sttaet and Number)
ro~ n~ec.~, sniNr tuci~ couNnr. ao~o~? . ~
and this statement ;s to be taken as my declaration of citiienship, actual leyal residanos snd domidle in the State of Florida.
(Inserf here any pertinent fatts, such as sale of property o? business, or relinqui:f~rrunt of emptoymsr~t
at former domicile, removal of family to new domidle, purchas~ of home, etc.) ~
HOMESTEAD PURPOSFS
T 6UC E COUNTY,~F~q,
RECORD VER~FIED
. ~ M~
'61 MAR 8 A~t (0 : QO
~o~e~ ~ 1533~1
$ ' CLERK CIRCUIT COURT
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I RIRTHER CERTIFY that i will comply wNh a11 othx rsquiren~snb of a Ispsl r~Ident of this StaM.
~ I FURTHER CERTIFY that I have no intention to retum to my former domiGle, and I intend to remain in FORT
~
PIERCE, SAINT LUCIE COUNTIf, FIORiDA, permanently.
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p."~-~,:~f~;~ - 108 E. PRIMA VISTA BLVD PT PIERCB,
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~ . •~~r"`~~,~'~ . - (Address) FLORIDA
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Swom to and subscribed before me this 8th daY ~ MARCH 19 6T .
.
~ee romu?s -
q~K ClRCUR COU~, . Notary Pubtic
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QY ~ D.G. My Gommiuion expi?es
(To b~ ~x~arNd in d~Ikaw snd oeiainal fil~d wMl~ CMrk Cinarif Carrl, and drplieal~ wilh Tax AwMOra
e~K 164 ~~c 2799
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