HomeMy WebLinkAbout0655 Declaration ot Domicile and Citisenship 163gp~
TO THE STATE AND COUNTY TAX ASSESSOR,
ST~UCIE COUNTY, FLORIDA:
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This is my declaration of Domici~e and Citizenship in the State of Florida that 1 am filing this day in accordance and
~n conformity with Chapter 222, Sectio~ 222.17, Florida Statutes.
1 was fo~merly a legal resident of _.___~hiCag0..- . It lineia
~C~y~ (State) ;
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and 1 resided at - __5008 NOrth WinChester However 1 have changed my domic~ile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _________kt-- - day of
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_I!!12~y-_ 19
6?, and 1 reside at 20 0 Sandia ~iVC ;
(Street and Number) ;
Port St. Lucie ~
FORT PIERCE, SAIN? LUCIE COUNTY. RORIDA
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and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida. z
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(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment i
at forme: domicile, removal of family to new domicile, purchase of home, etc.)
8stabiish Residency to enter school
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RE~OR~E
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~ ~LERK .
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~ I fURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
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1 FURTHER CERTIFY that I have no intention to return to my former domiGi~e, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~
~ (Name~tiilip oaig
~ ~ ,'J i.'
' (Addres
~ ; i ` ~ Pat Honig
~
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-~r =5wotn to and subsc~~ed before me this 24th day of .Ia.nuar~? , 19 68
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~ KO~~R • i~0,~ ' `
~ I61R ~O Notary Public
~ C~( ~~1~`~• 'URT
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~ gy D.C. My Commission expires
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~ (To b~ ~xecuted in duplicaM and oriyinal filed with CIKk G~cuit Court, and ~luplicat~ with Tax Ass~ssor.)
~ OR
~ , , . a~K 170 PACE 653
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