HomeMy WebLinkAbout2768 Declaration ot Domiciie and Citisanship 16~2~
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FLORIDA:
t
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
~n tonformity with Chapte~ 222, Settion 222.17, Florida Statutes.
I was forme~ly a legal resident of __w8iuli1lStet penQ• ~
(City) (State)
and 1 res~ded at ~_644 Catherine Stie@t ~~„~ever 1 have changed my domitile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _8t~ day of
i
e
Noyember ~9 67 and I ~es~de ai _2210 Deleware Ave. ~ ;
(Street and Number) `
~
;
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA .
and this statement is to be taken as my declaration ~f citizenship, actual legal residence and domicile in the State of Horida.
(I~sert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home; etc.)
. ;
, Establishing residence and applying for homestead ~
F~LED- AND RECOROED
ST. (,~~~E ~OUNTY. F~q,
RECORD VERIF1Fp
. ~~',~O
. '6e JAN S A,y 10 : 23 ~
i
f ''~v:_?Z i•
CLERK ~~RCUIr COURT
I FURTHER CERTIFY that 1 wiU oomply with afl other requirements of a legal resident of this State.
1 FURTHER CERTIFY that I have no intention to return to my former domiple, and I intend to remain in FORT
PIERC~, SAINT~ LUCIE COUNTY, FLORIDA, permanently.
```~^,,~t~iotrirr; n
~
,~t~tz . ~c~,; ,
~ v' trc'- (Name)
• . . - Paul Rose berger
' : n'.', -
~ ~ _ c.~ • ' -
~~v ' (Address)
. A t., Gladys A itosenberger
r~. J Sth Janaury 6 8
Swo~ri~to and subscribed before me this day of . 19 -
ROGER POITR/?S
lERK ~IRCUIT OURT Notary Public
' n x ires
gy D.C. My Commissio e p
(To b~ ~x~cvt~d in duplicat~ snd oripinal fil~d with Cl~rlc Circuit Cour~, snd duplica», with Tax Ass~swr.)
, ~
600fI M6f ~7~
` No. „ .