HomeMy WebLinkAbout2984 Declaratio~ ot Domicils and Citize~ship 15?7~
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. WCIE ~OUNTY, FLORI~A: ~
This is my declaratio~ of Oomicile and Citizenship in ths State of Flo~ida that 1 am filing thi: day in aooordanos and
in oonformity with Chapte~ 222, Section 222.17, Florida Statutes.
ROI~ NY .
I was fo~me~ly a legal resider~t of
(Ciy) (Stah)
and i resided at 21S Depe~ster St. . Flcwever 1 have chsn~ed my domi4le
' (Street and Number)
to and am and have bean a bona fide resident of the Stste of Florida since lZth day of
Novesber 66 Rt. 4 Bo~c 386
_ , 19 , and I reside at
(Street and Numbsr)
FORT MERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actusl legal residence and domidle in the State of Horids.
(Insert here any pe~tinent 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.)
FILING FC)R HOI~STBJID PURP0~3
FIL,ED AND RECORpH~~
ST. LUCIE EOUI~TY-. LA,'~
RECORD VERIFI~~
~6r ~uH 3o PM i l~~sso
~
RO^vE?~ r'017RAS i
CLERK CIRCUIT COURT
~ . ~
~
~
I FURTHER CERTIFY that 1 will oomply with all other requir~menri of a(e~al resident of this State.
I FURTHER CERTIFY that I have no intention b retum to my former domicale, and I intend to remain in FORT
PIERCE, SA~NT. .t~,lCIE COUNTY, FIORIDA, permanently.
,~tii~i~u::t:;;~~
~ti~~ r:: . C ii~, . . • -
v~ t O V -
, v Rj?~~i`-~':
~ .~;\i. . i~;,~
. i G~•.-~ ~ ;i ame)
: v., . ~o.
.
~ HARRY IN
!1 : - =
1 J;.~~ r:. • i~.`? .
~ - . . ~ ,-~7'.~~S . . t~.~ ~ ~ `
: th r,/`•'i~ j 't ~
- ; r~~:*-_•. (Address)
~r" , - - _
i
e
t,~ ~ ~ ~ ~
" .
Swarn to a~d subscribed before me this 30th day of J~e ~ ~q 6T
e~
i
RO~iER ITRAS
UIT Cpt~RT Notary Public
By ` D.C. My Commission expires
(To b~ ~x~cvhd in duplicata aad ori~inal fibd wilh Cl~lc Ciraiit CouA, ~nd dvplicaN wiTh Tax Aa~or.)
- • !o01~6 r~298~2
- . - ~
~ - v. ~
_ ~