HomeMy WebLinkAbout2967 ~e~la~ation ot Domicile and Citizenship
TO THE STATE AND ~OUNTY TAX ASSESSOR, 155444
Sl. IUCIE ~OUNTY, FIORIDA:
This i: my declaratio~ of Oomicile and Citi:enship in the State of Florida that 1 am filin~ this day in aoo~rdanoe and
~n cor~formity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a le9al resident of Net~1 Yor'k City . N Y
~Ciy~ (Stats)
and t resided a86- 56 ~loodhaven Blvd~ ~~„~ever I have chan~ad my domic~le
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since 2~d day of
Decenber ,~9.~i.l~._, and 1 ~eside at 1008 Chinnla Rnad
" (Shaet and Number)
FORT ~ERCE, SAIt~tT LUCIE COUNTY, RORIDA .
and this statement is to be taken as my declaration of citizenship, actusl tegal re:idence and domidle in fhe State of Florida.
(Insert here any pertinent facts, such as sale of property or busineu, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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$ntering~child in Dan Nc~rty High
fICED AND RECARDLtp~
. ST. LUC1E COUNTY. ~.A;~
- RECORD VERIFIEO
155444
~ 'fiT APR 21 AN 10: 51
.
RO~LR POITRAS
CLERK CIRCUIT COUST
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1 RIRTHER CERTIFY thst 1 will oomply with all other requiremenis of a lepal resident of thi: State.
I FURTHER CERTIFY that 1 have no intention to retum to my former domivle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, fLORIDA, permanently. - D
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SworA ro and subscribed before me this ~ day of ~p~ , 196~_-
ROGER ~OITRAS
CIRCUR Notary Public
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By D.C. My Commission expires
(Te b~ axa~uhd In duplieaN and ariyinal Hl~d wi~h Cl~tlc Cirarif Coue~, and duplkah wilh Tax AsNa~or.)
~ d00K~65 PAGEiG9l1~ 3
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