HomeMy WebLinkAbout2128 D~IAratton ot Domicii• and Citis~nship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, fIORIDA:
This is my deduation of Oomicile and Citizenihip in the State of F{orida that I am filirp this day in aooordana ~nd
in aonfo?mity with Chapter 224, S~ction 222.17, Rorida Statut~s.
1 was forms~ly a Ipal rosidsnt of ~bequetque NeM ~kX3C0
(City) (Stats)
and 1 rosided at Box 2S, Star loute ; my
(Street and Number)
to and am and,have been a bona fide rosident of the State of Ftorida sinoe September 16 ~y
~ 3428 So. Piaea H#~.
, 19~l~, and 1 roside at
(Street and Number)
I~ORT MQCE, SAINT ltK~ COUNTY, RORIDA
and this statsrt~snt is ro be taksn as my declaration of citi=enahip, actval legal ~esidenos and domicile in the State of Horida.
pnsert here any pe~tinent fsds, such as sale of property or business, or rolinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Sstablishing residence - purchased homestead in Ft. pierce
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i ft1RTHER ~HtTIFY that i will compiy with afl ott~sr requimrr~nts of a lepal residsM of this Stah.
1 FURTHER CERTIFY that I have no intention to retum to my former domidle, and i intend to remsin in FORT
PIERCE, SAINT LUCIE COUNTY, RORIDA, permanentiy. ~
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s/
~ . - t~~) B. Peter Herzog
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~ . . _ - (address) • e r
" , _ : .
- ~ ' ~ September ~
:'.Sw' ~ to. a~d wbsuibed beforo me thif 25th day of 19~$._.
. ~ ~
RO~iER ~OITRAS
CLERK CIRCWT COURT Natsry Public
By D.C. My Gommiss'wn expires
~ R~ b~ ~oc~wl~d in d~pUca~N and ari~inai Hl~d w116 Ci~lc Ci~+aiit Ceu~, and dvpliu» will~ Tax As~o~J
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