HomeMy WebLinkAbout2684 Decla~ation ot Domfcile and Citiz~nship
163~2i
TO THE STATE AND COUNTY TAX ASSESSOR.
Sl. UKIE COUNTY, FLORIOA:
This is my declaration of Domicile and Citizenship in the State of Flo~ida that 1 am filing this day in acoordanoe and
in tonformity with Chapter 222, Settion 222.17, Florida Statutes.
1 was formerly a legal resident of ~i#~~C _A__ Neti Yort
(C~ty) (State)
and 1 resided at R~P~ D~ ~`1 BQx 57 However I have changed my domitile
(St~eet arx! Number)
to and am and have been a bona fide ~eside~t of the State of Florida since _--_283h._ day of
-_~[4~Cl.<b~L, 19..~~., and I reside at 1104 Se,~ino~e Drive
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, ROlt1~A
and this statement is to be taken as my declaration of citizenship, actual legal.residence and domicile in th~ State of Flo~ida. I
(Insert here any pertinent fads, such as sale of properry or business, or relinquishment of employme~t ~
at forme~ domicile, removal of family to new domicile, purchase of home, etc.)
Establish Residency for Homestead purposes ~
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RECOROED ~
i FILED ANO ,
i ST.`~UCORUOU~~Y~D A.. ~
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163~1 ; y6 ~
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CLE~K C~RCUIT COURT ~
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I FURTHER CERTIFY fhat I will oomply with all other requirements of a legal resident of this State. ~
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1 FURTHER CERTIFY that I have no intenfion to return to my former domiGle, and I intend to remain in FORT
PIERCE, SAINT IUCIE COUNTY, FLORIDA, permanently.
Lee w. ~'~~r
ANy Gas _ dress)
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~•.$virpm to~and subxribed before me this 3rd day of -j~u~rY , lq 6t ,
/ - •
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~ R06E~~AOITI~19
CL~RK-CI _RCt~lf COtJ Notary Public
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gj~. ~ - O.C. My Commission expires i
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(T~ b~ naeul~d in dupliea?~ snd ori~pnal fil~d witl~ Cl~ek Ci?euil Courl, and duplieaf~ wiTh Tax Ass~stor.)
g~K 16y PAC~ ~665
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