HomeMy WebLinkAbout1236 Declaration ot Domicile and Citizenship ~~142
TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FLORIDA:
This is my declaration of ~vmicile and ~itizo~ship in the State of Flo~ida that I am filin~ this day in aoo~~danos and
in confo~mity with Chapter 222, Section 222.17, Florida Statutes.
1 was forme~ly a legal ~esident of ~a][~~E~X Ai~sl~8 Fa~ le New York
(Ciy) (Staro)
and 1 ~esided at 'S00 Jeffe]CSOri Ave . Fbwever I have changed my domitile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since .bth day of
_ MaT___ , t9~, and i reside at 110 Boeton Avenue ,
(Street a~d Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual lega) residence and domicile in the State of Florida.
(Insert here any pertinent facls, such as sale of property or busineu, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
citizenship in State of-Florida
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1 FURTHER G'ERTIFY that I will comply with all other requirements of a le~al resident of this State.
I FURTHER CERTIFY that I have no intention to retum to my former domicyle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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(Name) Thomss M Phe18II
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(Address? 110 Boston Ave
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Sworn.to . • ~~4ed before me this -~l st day of J~g , 19_~2$ E
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~ItK CIRCUIt bRT , Notary Public
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g r1 ~ D.C. My Gommission expires
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(TO b~ ~icbwl.~ll ~ d~pticab and oripinai fj~ wiN~ C'1~ek Cirarit Cou~, and dupliuta wi~h Tax A~er.)
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