HomeMy WebLinkAbout0475 D~aia~ation o~ Domicll~ and CIti~MShip ~~350G
TO THE STATE AND COUNTY TAX A,SSESSOR,
St. I.l1GIE COUNTY, FLORI~A:
This i: my deduation of Domial~ and Ctisenship in th~ Sta» of Florida that I am filin~ thls day in ~ooo~rno~ ~nd
in oonformily with ChaptK 22Z, Ssttion 222.17, Florida Stafut~s.
I was forn~erly a Ipal rosident of AMITYVILLB [~IHW YORY
Ki~Y) (Sta»)
and 1 hsid~d at ?4 NORMIlN AYBNUB . Howw~ 1 haw d~arp~d my domWl~
(Stresf and Numbsr)
ro and ~m and have been a bona fids rosldent of tM Stat~ of Florida stno~ 26th ~y ~
AUGU3T ~ ~q 68 ~ Z422 ATLANrIC B~Al.`~i BLVD.,PT.
(Strost and Number) PIBRCE, FLA.
l~OtT M~CE. ~AWT WCiE COUNTY, RORnA
and this stat~?ment is ro be takan as my dscla~ation of dtizenship, actual ipal residenos and domidle in the State of Horid~. ~
pnsert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at forrr~ domidle, romoval of family to new domicile, purchase of ~wme, etc.)
HOMESrBAD PURPOSBS
. .m.Y"~' y~ . _
FILEO AN~ RE 0,~~.'.
ST. LUCIE COU~~. ~ ~
RECORD VERIFtE /
:i~~`'~~'`~c~
'69 JAN 6 AM ~o ~ ~
~'~35Q0
~ - ROGEK PO~TRAS
; CLERK CIRCUIT COURT!
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i FURTHER Cf~tTIFY that I will aomply with all other r~quirem~nt~ of s lepal r~ident of thls Sfab.
I FURTHER CERTIFY that I have no intention ro retum to my former domicile, and i intend to remain in FORT
PIERCE, S~AINT LUCIE COUNTIf, H.ORIDA, permanently.
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~ LNRViili ?iVilYD
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~ ~ ~ ; = 2422 ATLANrIC BBACH BLVD. PT .PIBRCB,
~ - (~lddress) FLORIDA
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gv~r'¢cq~o and '~t~qbsd before me this 6th day ~ JAIv UARY ~ ~ q 6 9,
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CIRCtAT Notary Public
By D.C. My Commission expiros
~ R~ b~ ~oawt~i i~ d~pNcaN aAd oei~iual f~d wi* CI«k CMw~if Cewf, and aupNa~h w~ T~c /?~..MO~J
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