HomeMy WebLinkAbout0564 D~cla~atlo~ ot Domicil• and Citis~nship 1~+35`73
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. llJC1E COUNTY, FLORIDA:
Thi: is my decla~ation of Oomicile and Gitiztnship ln ths Stats of Horida that I am filinq this day in aooo~d~na ~nd
in aonformity with Chapter 222. Ssction 222.17, Horida Statutes.
1 was fo~marly a le~al ~~idant of GRSBNSBHRG PBNNSYLVAN IA
(City) (Stah)
and 1 rosidsd at 622 PARK LANB Hcwever 1 have chan~ed my domWl~
(Street and Number)
ro and sm and hava been a bona fide resident of the State of Florida s~noe 3rd ~y ~
OCTOBBR
~q 68 , a~ ~~~e ~ 220 BANYA!~ DRIVB?PT_ST_LUGTR~ FLr.RIj~
(Sfreet and Numbsr)
I~ORT MQC~, sA1NT L11C~ COtINTY, RORIDA
and this atstement is ro be taken as my dedaratan of citi~enship, actual leysl residenoe and domidle in the State of Horida.
qnsert hero any peMine~t facta, such as sale of property or business, or relinquishment of employmer?t
at former domkile, removai of~fsmily to new domicile, purchase of home, etcJ
HOMESTEAD PURPOSBS
Ft~O AND RECOFtO D
S?. LUCIE COUNT~f.
RECO ~J VERIF~~
c•t
'69 JAN wM 1 ~
1'735
ROGER P017RA5
; C~ERK CIRCUIT COURT,
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i FURTHER GHtTIFY that I will aomply with ali other re~iremsnts of a lepal roside~t of thb SMts. ~
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I FURTHER CERTIFY that I have no intention to retum to my former domicile, and 1 intend to remsin in FORT
PIERCE, SAINT LtICIE_COUIV7Y, FLORIDA, permanently.
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~ , ~ i ~ CHARLES H . HOSTERMAN tName) ~
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~ ~~T• 220 BANYAI~I DRIVB,PT.ST.LUCiE, FLORIDA
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~~~Swot~. to a~'~obsuibed before me this ~ day of 19 G 9. :
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Ro~~ ~c~r~?s
caecur~ co~r Not.ry ~,~k
By D.C. My Commission expires
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Ro b~ ~arhd iu ~ and o~i~iaal t~d wilh CM~k CiraiM CwiR, and dvpliah wilh Tax As~~a,1
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