HomeMy WebLinkAbout1821 Decla~~tion ot Domictle and Cittsenship
~15~8869
TO THE STATE AND ~OUNTY TAX ASSESSOR, _
51. IUCIE GOUNTY. FLORIDA: ~
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This is my decla~ation of Oomicile and Citizenship in the State of Floride that i am filin~ thii day in accordanos and '
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~n conformity with Chapter 222, Sectior? 222.17, Florida Statutes. !
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I was formerly a legal resident of Long Island Nett Yo~Ic '
~~i~y~ (Stat~)
and 1 resided at ~~e . However I have chan~sd my domidle
(Street and Number)
ro and am and hsve been a bona fide resident of the Stats of Florida sinoe day of
, 19~_, and I reside at T65 ~g'~ssa
(Street and Number)
FORT MERCE, SAINT LUCIE COUNTY, IRORIDA
and this statement is to be taken as my declaration of citizenship, attuel lagal residence and domicile in the State of Horido.
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(Insert hare any pertinent facts, such as sale of property or busineu, or relinqulshment of employment ~
at former domicile, removal of family to new domicile, purchase of home, etc.) i
~stablishing residence r _ _
~tering child in school . ' . •
FILEO ANp R~CORDED'
ST. LUCIE COUNTY. RLA.
RECORD YERIFIED
~ ~l 115886~
~ 3 ~ 49
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~ F~O~sE~? r'0lTRAS
C CLERK CIRCUIT COURT
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e
1 FURTHER CERTIFY t~at I will aomply with all other requiremenh of a le~al resident of this State.
I FURTHER CERTIFY that 1 have no intention to retum to my former domiCile, and I intend to remain in FORT
PIERCE, ,~Sj41iNP~IJ~~ .C,QUNTY, FLORIDA, permanently.
_ _ :.....:;,~lJ~`~•. ~ ~ -
, ',~t•:,!-'. i C'~ j
, , a: y ~(Name) ;
. c ' . - Gino ppa ~
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.~-'~n~•. ~ ; " _ _
• • ~ddress)
• ~ , ;~t; j~r ~~~`..A ~ G102'ia pp8
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Sworn to and :ubsuibed before me thia ?th day of ~u8t .~q 67 ~
ROGER rO1TRA5 i
CIRCUR CO RT Notary Public
~ ir
gy D.C. My ~ommisswn exp es
(To b~ ~x~cul~d in duplisab and ori~inal Al~d wiN~ ClKic Cirarif Couet, and duplicab whh Tax A~.) "
. mK167 P~182~
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