HomeMy WebLinkAbout0928 f
. ~
Oeclaration ot Domicile and Citizenship 1s39`~'
8
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE ~OUNTY. FIORIDA:
;
~
i
This is my decla~ation of Oomicile and Citizenship in the State of Florida that 1 am fiiing th~s dsy in eaordante a~d '
in conformity with Chapter 224, Settion 222.17, Flo~ida Statutes.
I was formerly a legal resident of ~-~~Ne1~1 YOt1C C3 t~? N Y ~
(City) (State) ;
~
end 1 ~esided at _56 B 59th Strcet . Fbwever I have changed my domicile ±
(Street and Number) '
~
to and am and have been a bona fide resident of the State of Florida since ZTth day of
~rcb _ , 19 6? , and I reside at 755 Gypr~ss St River Park ~ ~
(Street and Number)
fORT PIERCE, SAINT tUCtE COUNTY, FtOR1DA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here any pertinent facts, sucF~ as sate of property or busineu, or reiinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Bstablishing residence
R)~Ep ;
9T, lU~
E
C RECpRpg~ . ;
OVN
R~coRO VER~~Ep~~
•6B ~ 1s,39~~
~ 3! PH !2 : 23 `
t
r~o~,~K~ ~
ERK C,RCV~T ~~uRT :
~
~
~
t
~
~
I FURTHER CERTIFY that I will comply with all other requirements of a leqa) resident of this State. ~
i
! FURTHER CERTIFY that 1 have no intention to return to my former domi4le, and 1 intend to remain in FORT ~
_ PIERCE, SAtNI' LUCtE COUNTY, FL02iDA, permanently. " - ~
~~~i~i~~~~:::;i~~, ' ~
,~~,~~~oG.. ,
.''.5'c''~!~~~'~` ' (Name) 1
V .1~ - : - ! ~ Gr0 : ~ F10te~1CC ~I TObi~,S
- ~ G: .s
~ - r, • .
~
= ~ " ~ (Address)
r - :
= ,
: . . ~
•G~
~'3w~orn~M`and subxribed before me this 31 day of January ~ 19 68
R ER POITRAS
CIRCUIT C//~~/~)/~RT Notary Pu~lic
V v`~~ . . . f
gy D.C. My Cammiss~on expires ~
+
{To b~ ~xecwtd In dupllcab and orj~insl Al~d with Cl~rk GrwH Cou~, and dupliu~ with Tax A~saor.) .
dO~K 1 rj~ P~CE 9~~ ~
_ .
.r~ ~ ~ - -;~=x~' ~ =
, ~
_a~=;;:~
.