HomeMy WebLinkAbout0895 ~
~eclaratto~ ot Domicile and Citizenship
• 1'~381y
TO THE STATE AND CWNTY TAX ASSESSOR,
;
51. LUCIE COUNTY, FLORIDA: ~
This is my declaration of Domicile and Citizenship in the State of Flwida that I am filing this day in acoordanoe a~d
in oonformity with Chapter 222, Section 222.17, Florida Statutes.
1 was forme~ly a legal resident of L• I~ N. Y.
(City) ~a~) ~
i
,
and I resided at3508 Beltaugh Ave , Bellmoore, L. I. ~,,,,ever 1 have changed my domicile
(Street and Number)
to and am and have been a bo~a fide ~eside~t of the State of Florida since September day of
, 19 68 , and I reside at 240 Batlyoll Drive
(Street and Number) a
~
FORT MERCE, SAfNT LtlCIE COUNTY, RORIDA ;
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
pnsert here any pertine~t facts, such as sale of property or busineu, or relinq~[ishment of employme~t
at former domicile, removal of family to new domicile, purchase of home, ett.)
Homestead purposes
s
• !
3
FIl.EO ANO REC~JROEO ~ . ~
ST. LUCIE COUNTY~ ~l.A• ;
REC j`~a~i~o
'I ~
'69 JAN I q AM t0 : 3~
i ~f ` `
! R R ~ OITRAS
, CLE CtRCUIT COURT1
E ~
~
~
1 FURTHER ~fRTIFY that 1 will oomply with all other requiremenis of a layal resident of this State.
1 FURTHER CEf~IFY that f have no intention to retum to my former domiti~e, and I intend to remain in FORT
;
PIERCE, SAIN~'-LlK1~ COf~NTY, FLORIDA, permanently.
_ . . - . i I
.
- ~ ~i
~ ~ . ' - (Name) Bllen . Bay
- - ~ ~
~ ~ . , . ~
~ .
~ ~ , (Address)
~ .
~ Swom ro and subsuibed before me this. 14th day of January , 1969
~ •
~
ROGER rO1TRAS
CL~RK CIRCWT COURT Notary Public
8y - 0.C. My Commiuior~ expires
~
R~ w~ iw du'Iica1~ a~ orioiw~l Al~d wMl~ Clwic Ciraiit Cov~t. and duplieat~ wilh Ta~c As~or.I
~i~5 ~ ~ ~
_ _ _ . . . - _ ,g~~~
~~.s~~ _ a_ -W - ~ - - ~ ~ _ ~