HomeMy WebLinkAbout0303 Decla~ation ot DomiCile and Citlse~ship
163b"~'8
TO THE STATE AND COUNTY TAX ASSESSOR, .
51. LUCIE COUNTY, FLORIOA: '
This is my dectaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance a~d
~n conformity with Chapte~ 222, Section 222.17, Flo•ida Statutes.
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1 was formerly a legal reside~t of __GE_'n0_S NeW YOrk _
~~~fy~ (State)
and I resided at _____GenOa_ RD_ ~1 However I have changed my domic.ile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _$~t1_--_--- _ day of
_____August ~q 67_, and I reside ar 110 West Prima Vista, Pt St. Lucie
(Street and Number)
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FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert 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.)
Homestead purposes
FILEO AND RECORO~ELA.
ST. LUCIE COUNTY.
~~.corn ~636'78
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68 J~ ~
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CL~RK CiRCUIT COURT ~
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~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domiule, and I intend to remain in FORT :
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~ PIERCE, :~lT~Ul.C1E COltNTY, FLORIDA, permanently. :
' _ . . ~
~ - ' _ C~~~
_ - ~ _ (Name)
- ~ ~ ~ - " Donald Curtis
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' ~ ~ (Address) ~
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~ Sworn to and subscribed before me this 19 day of J~uary ~ ~q 68 ~
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~ ROGER POITRAS
~ CLERK CIRCUIT COURT Notary Public
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gy ~ (~0~-t.~~~ D.C. My Commission expires
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~ Ro bs ~xecut~d in dupliuh and original Rlsd with Clerk Grcuit Cou~f, and duplicatt with Tax Ass~ssor.)
a~x 170 P~~ 303
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