HomeMy WebLinkAbout0946 Dec~aratio~ ot Don~icil~ a~d Citisenship i
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TO THE STATE AN~ COUNTY TAX ASSESSOR. 162121 +
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51. WGE COUNTY, FIORIDA: . . !
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This is my decla~ation of Oomicile and Citizenship in ths Stats of Floride th~t 1 am filinq this day in aooo~dana ~nd ~
~n co~f~rmiiy w+th Chapte~ ~22, Section 2~Z.17, Florida Statutes.
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1 was forme~ly a ~ega1 res~denr of SoYder out of 8uf f alo New York
(~iq) (Sts1~)
and 1 resided at _ 18 CODCOtd P1aCe Hcwevar ! have chanQed my ~rnidle
(Str~et and Numbe~)
ro and sm and have bee~ a bona fide resident of the Stete of Floride since - 3rd dey of '
January 67 8903 So Iad.River Drive
, 19 , and 1 ~eside at
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fORT ~IERCE, SAINT i.UC1E COUNTY, RORIDA
and this stateme~t is to be taken as my declaration of citizenship, sctusl iagal residence and domidle in the State of Horida.
pnsert here any pertinent fatts, such as sale of property or busineu, or relinquishment of employment
at former domicile, removal of family to new domicile, putthase of home, etc.)
Establishing residence
FILEO ANO RECORDED
5 LUCIE COUNTY. FLA.
~:.r~,~a~ ~ FIF~~I)
- 1621~1 :
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~ '67 M~t'! 2 8 PM I: 55
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ClE?iK CiRCLIT COURT ~
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1 FURTHER CERTIFY that 1 will oomply with a!I other requireme~ts of a le~a) resident of thia State. ~
I FURTHER CERTIFY that 1 have no intention to retum to my former domiG~e, and 1 intend to remain in FORT ~j
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PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. i
" - - C? ~ ~ . ~ ~
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, ~ ~ ' ~ (Name) ;
: • ~ Carl H~ Zierk ~
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, . 28th November , 19 6?
.,S,wqrn to and suliscribed before me this day of •
rom~?s
CtRCUR COURT Notary Public
g,~ O.C. My Commission expires
(To b~ ~x~art~d in depNcah and ori~iesl ~I~d wilh Cl~k Ci~t Co~rr~, and duplicNs wiN~ Tax As~or.) i
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