HomeMy WebLinkAbout1405 Decla~atio~ ot Domicile and Citizenship
TO THE STATE ANO COUNTY TAX ASSESSOR, 164300 ,
51. IUCIE COUNTIf, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in actordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerl a I al resident of __H@1R_.YQrj[ C Near Ynrk _
Y e9 ~Y----- -
~~;fy~ (State}
1323 Cornaga AV@ • . However I have chan ed m domicjle
and I resided at - - - - - - 9 Y
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since 1$.t_ - day of
December 19 67_, and 1 reside at ?41 Fernandina Street
(Sireet and Number) l
FORT PIERCE, SAtNT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual lega) residence and domicile in the St~te 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.)
Establishing reaidence
FILED ANO RECORDEO~
ST. LUCIE COUNTY. FLA:~`
RE:CO?D Vi~?~tF~FD
-ts43oo
'68 fE6 12 PN 2: Z2
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ROvER F~OITR~.S
CIERK CIRCUIT COURT
I FURTHER CERTIFY that I will comply with all other requirementa of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiCu~e, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_
';_~»!~.,...~`c:'~~~;. - (Name)
- - _ ! -~~o~;fi Dr. albert Schur
A~ ~/1~
` ~ J ' t • ~ ~ ~ d~~/~~L~~tiV
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•
- c~`•, , _ ~ ~ ~t z (Address)
. :
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~ Swdrli'to and subscriberJ before me this 12th day of February ~ 1968
ER POITRAS
~K
JCIRCjjIT~ Notary Public
D.C. My Commission expires
(To bs executed in duplicate and originsl filed with ClerffT.ircuit Court, snd duplicste with Tax Assessor.)
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