HomeMy WebLinkAbout0575 - D~ctaration ot Don~icll• and Cltis~nship -~'73581
TO THE STATE AND GOUNTY TAX A ~iSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
This is my sleclaration of ~omicile and Citlzenship in the State of Florida that 1~m fllinq this day in aooo~dano~ end
in ow~formity with Chapter 222, Settion 222.17, Florida Statutes.
i wa: form.rly a Ipal rosident of Portchester N. Y. -
(City) (Sta»)
snd 1 rostdsd st 401 N. Ma1II StTeet 1~~ ~r~
(Stroet and Number)
ro and am end haw been a bona fids resident of the State of Florida sinoe January 1 ~y ~
, ~9~$_, and ~ ros~de at HOlopaw Ave . Rt. 2~ Boz 5344
(Sfteef and Numbsr)
l~ORT MiRCE, SAINT 11~C1E COUNTY, I~tORIDA
and this :tstement is ro be tsken ss my declaration of atizenship, actual le~el residenae and domicile in the Stat~e of Horida.
pnsert hero any pe~ti~ent facts, suc~ as sale of property or business, or rolinquiahment of emplayment
at formK domicile, removal of family to new domiaie, purchase of home, etc.)
FILEO AND RECORDED
Filing homeateed ST. 4UCiE COUNtY ~LA.
RECORD VERIFt~D
~ 17'3581
'69 ,1AN PN 12 : 23
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Ro ~o~rRas
CLE GIRCUtT COURT-
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1 FURTHER CgtTIFY that I will oomply with all ott~ roquirerr~ts of a(epal ~esidsnt of thi: Stste.
i FURTHER CERTIFY thst 1 have ~o intention b retum.to my former domicjle, and i intend to remain in FORT
PIERCE, SAINT LU~IE COUNTY, FLORIDA, permanently.
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` v~_ : ~~iyG~Ji,C~ ~
i:_' _ ~me~ Gabriel Romain
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~i < :'+7 _ ' (Address)
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d - : t _ ;f:=
-:~ri~fo ~ri~d's~bs~tied bsfore me this 7th day ~ Js]uu82'y 19SL~.
~•;~^,.....G~.~ ~,c- ,
.R~R ..t~S
CLERIC G~GNT CONRT Notary Publk
By O.C. My Gommission expires
(T~ b~ ~onevl~d i~ dupiisala and eriaiaal Nl~d wflb Cl~elc CiraiN Co~h, and duplicaN willi Taoc A~er.)
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