HomeMy WebLinkAbout0095 Declaration ot Domicile and Citizenship
163530
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FIORIDA:
This is my decla~ation of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statvter.'
I was formerly a legal res~der?t of Hew _ Yo rk Ci t q _ New YO rk
(Ciy) (Stbte)
and t resided at _ 617 _?6 StZtEt_ WeSt ~wever 1 have changed my domiCi~e ~
(Street and Numbe~) '
to and am a~d have been a bona fide resident of the State of Florida since _ day of
April , ~q 6S and I reside at 605 Beach Ave ~ Riaer Park
(Street and Numbe~)
FORT PIERCE, SAINT LUCIE COUNTY, FIORIDA -
and this statement is fo be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Inse~t here any pertinent facts, 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
FIIED AND UNTY DF A'~'
ST~RE_ OFd ~FRIFIED
163530
~ 8 JAN IG PM 1:4~
6
~~o~;,:_?~ ~~o:?~r.s
C1.ERK CIRCUIT COUR7
I FURTHER CERTIFlf that I will comply with all other requirements of a legal resident of this State.
1 FURTHER CER7IFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT IUCIE COUNTY, FLORIDA, permanently. _
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~C~~; ~ c: Glad (Name) MorsC '
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Swdrn~to'dnd subscribed before me this 16th day of Janaurq ~q 68
. •
ROGER POITRAS !
K CIRCUIT COURT ~
Notary Pubtic
~Y D.C. My Commtssion expires
(To b~ ~x~eut~e! in dupliub and oriQinal R witli Clyic Greuit Court, and duplieat~ with Tax Ass~ssor.) ;
a~K1?'0 ~ 95
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