HomeMy WebLinkAbout0100 D~cla~atio~ 01 Daniall~ and Citis~nship
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TO THE STATE AN~ COUNTY TAX ASSESSOR,
St. lUC1E COUNTY. FLORIDA: , .
This is my dxla~stion of Domidle a~d Citizenship in th~ State of Horida that I~m filir+~ this day i~ aooordario~ ~nd
in ooniormity with Chapter 422, Settion 222.17, Florida Shtut~s.
~ was formerly a ~pa! rosident of Rochester New Yor~[
(City) tSta»)
and 1 roslded ar 4Q Ingomar Drive . HowwK ~ hav~ d,an~sc! my domidl~
(Str~et and Numbsr)
ro and am and have been a bona fids rosident of th~ Stsro of Fbrida sinoe 30th ~y ~
November , ~q 68a~ n 135 Lobster Road ~
(Sh~st and Number)
laORT MQC~, SANrT LlJC~ COUNTY. lLOR~A ~
and this stat~ment is to be taken as my dedsration of ati~snship, actual legal res'~denos and domkile in fhe State of Horid~. ~
(Insert here any pertinent fachs, such as sale of property or business, or ~elinquishment of employm~nt
st formar domkile, removal of family to new domiale, purcha~ of home, etc.)
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~ I FURT!#R CfltTfFY that 1 wlll aomply with ali otF~ roquinm~nis of a lepal ~ident of this Sta».
1 FURTHER CERTIFY that 1 have no intention t~o retum to my former i41e, and 1 intend b remain in FORT
PIERCE, SAlNT U1CIE COUNTIf, FIORIDA, permanently. ~
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t ~:1~111~1i1?!l:j~? -
; :-~L~i i ~ - ; . BRNESr H. PINK ;
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~ i-- 135 Lobsf~er Road, Pt. St. Lucie
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,~q~,~'lnd substrib~d b~f~o~~ mt this d~y of - ~,e . 19S[L.
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C'udC C~qll'T GOllr~ Notary P~lic .
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8~r . . My Ganmis~a+ ~cpi?u
tTi w a~a~ M i~IkaN awi «i~M~l ~i wilM Cf~k CM~wM Gw~, aai ~ wilM Taa A~w?~
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