HomeMy WebLinkAbout1152 ~ 164i1~
Declaratlon ot ~omicile and Citizenship
TO THE STATE AN~ COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FIORIDA:
This is my declaration of Oomicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of .___~Q~~1~____-__ NBw YorY _
(C;ty) (State)
and I resided at ___66 Aalt@r A~eYfue However I have changed my domicjle
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ____'~SS~ - day of
_______1$D1~8r~_-_--__, 19-~$, and I reside at 31~9~~Rrbrenlr Zlri~~? pnrt 3t.LuQig
(Street and Number)
~ORT PlERCE, SAINT LUCIE COUNTY, RORIDA
and this staiement 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, ~emoval of family to new domicile, purchase of home, etc.)
Eatablieh 8esideao~ Sor hoseetead purpoeeB
I', RECORDE~,
; FILEO AN CpUNTY• F~-p''
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f CIRCUIT C~~
~~ERK
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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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~ I FURTHER CERTIFY that 1 have no intention to retum to my former domic,ile, and I intend to remain in FORT
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PIERGE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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(Name) g e GtBC 6 I. 11
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(Address)
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_ Swprn~ tt~ and subscribed before me this 6th day of Februarv~_, 19~2~.
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- ,CL~RK CIR~W~;CflU Notary Public
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By: " O.C. My Commission-expires
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~ (To bq; ~4~pcutid in duplicate and origin~l filed with Cbrk Circuit Court, and dupliwte with Tax Assessor.)
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