HomeMy WebLinkAbout1396 ~sala~atlo~ ot Domicfl~ ~~t! Citi=en~hip ~ t
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TO THE STATE AMO COUNTY TAX ASSE_CSOR, -j.s,2,~~?~ ~
51. IUCIF COUNTY, FLORIOA:
This is my declaratior~ of Domicile and Citizenship in ths State of Florida that 1 am fili~p this dsy i~ aooordanoe and ~
in conformiry with ~,fiapter 222. Sectio~ 222.17, Florida Ststuhs. . :
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1 was fo~me?!y a legal resident of ZSlip ^ New Y'T~
(City) iStah)
and 1 resided at 188 Union Ave. , Hpwever 1 hsva tharpad my domi~ile
(Stroet and Number)
to end am and have been a bona fide ~esidant of th~ Stats of florida since - lOth day of
u 1~? , 14~~6 and I reside at .
(Str and Numbsr)
~ORT'IHtCE, SAIiNT LUCIE COUNTY, RORIDA ~
and this statement is to be taken as my declaration of citizenship, actual lagal resider~os and domidle in ihe State of Florida.
(inserr here any pertinent facts, such as sale of property or business, or relinquishment of employmsnt ~
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at former domicile, remova! oi family to new domicite, purchase of home, etc.) ~
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Bstablishing residence
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F~~~ AND RECOROEp!
ST. WCIE COUNTY. F~A: -
RFCORD V~{~IFIEp '
'6T ~E 16241 ~ '
~ 7 PM i:y~ ;
I
~o~~ r•o~sRas `
CLERK ~
CJRCUlT COURT ~
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1 R1RT}:ER CERTIFY that 1 will aomply with al! oM~er requirements of a ie~al resident of fhis State. ~
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I FURTHER CERTIFY that 1 hsve no intention to retum to my former domicjle, and ! intend to remain in FORT ;
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PIcRCE, SAINT LUCIE COUMY, FLORIDA, permanently.
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: . . ,''a • C ;^1 i~i . . '
. J . ~ (Name)
' v - • ~ Ja w. Noulitc
' - . i G:.~• ,
_y' ~:,j._ ` _'1 r•'- _ / ,
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. _ _ - Car01 _
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~ yn uli]c
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,~iddor~:~o:s~ wbxribed before me this 7th ~y of Deceaber 19~.6.7
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ROGER ~0t1~AS
CIRCtIR COI~T Not~ry Public
B a'`~'`"'~~ D.C. My Cornmiuion expires
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Ro b~ ~x~aM~d i~ duplicah and ori0i~1 Al~d wjtiM tl~eic p~arit Goue~, and depl~cNs wilb tau AwMOr.) j
ac~K ~69 Pact ~
1384