HomeMy WebLinkAbout0947 D~claration ot Oomicil~ and Cltisen~thip
TO THE STATE AN~ COUNTY TAX ASSESSOR, ~V2~
Sl. lUC1E COUNI'Y, FLORIDA:
This is my decla~ati~n of Domicile and Citiienship in the State of Florida thst 1 am filiny this day in aooordanoe and
~n conformity with Chapter 224, Section 222.17, Florida Statutes.
1 was formerly a leg~al ~esident of Twin l~ountaia New Hampsbire
(Ciy) (Staro) "
and ! ~esided at Rt 302 Box ~4 _ , t~owever I have changed my domiCile ~
(Straet and Number) ~
ro and am a~d have been a bona fide resident of the Stste of Florida since 23rd dey of ~
i
Pl ve~bPr , 19_5.?, and I resicle at _ Rt = BaY ~6$
(Street and Number)
fORT PIERCE, SAINT IUCiE COUNiY, RORIDA ` . ;
and this statement is to be taken as my declaration of citizenship, attusl legal residence and domitile in the State of Horida. ~
~
~
(Insert here any pertinent facts, such as sate of property or business, ar relinquishment of employment ~
at former domicile, removal of family to ~ew domicile, purchase of home, etc.) ~
i
Entering Jeffery Kosack in the lst grade '
" Ronald St. Germain in the 6th grade
n ~
Gary St. Gersain in the lOth grade ~
~
3
t
ST
V~ ~
C REC~RO
•._coR~ ovR ~Y~ ~q.
.s~ N~ lsz~z
28 PM I;SS
c~ERocr,? : o~ ~ -
K CI
Rcv~T ~~URT
I fURTHER CERTIFY that I will oomply with all other requiremenri of a leyal ~esident of this State.
~ ~
• i
I FURTHER CERTIFY that 1 have no intention to retum :o my former domicjle. and I intend to remain in FORT !
PlERCE, SAINT tUCIE COUNTY, FLORIDA, permanerttly.
~
~ ~ x - G%~~
-s,t ~ . (Name) -
s ~ Josepb R. ltosack ~
. ~
~ ~ ` tI. ~ . (Address)
. ` _r `v ~6 . i
Sworn to and subscribed before me this 29th day of November , ~q~_7
~
i
ROGER POITRAS
GtRCUR C URT Notary Public
e..c-.E.c.~. ~
8y D.C. My ~ommission expires
(To b~ ~xacuhd in duplicat~ and oriain~l fil~d wbh Cl~rlc Grarit CarA, and duplicat~ with Tax Ass~ssor.)
E~0l~ ~Ab'E ~~j .
_ _
~
i