HomeMy WebLinkAbout1009 Oeciaratian ot Domicile a~d Citizenship 1,~,~2
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T4 THE ST~4TE AND COUNTY TAX ASSESSOR, ' ~
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Sl, IUCIE COUNTY, FLORIDA:
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This is my declaration of Domicile and Citizenship in the State of Florida fhat 1 am filin~ this day in aaordanoe and ~
~n confo~mity with Chapter 222. Section 222.17, Florida Statutes.
I was formsrly a legal ~esident of Quo~ue, Long Islan~_ NeW Y~rk
(City) (State)
and I ~esided at willOw Avenue , liowever ~ ysvecharped my domiale
(Street and Numbe?)
to and am and have been a bona fide resident of the State of Florida since 15th ~Y ~
September ~9 68 , and ~ reside at 750 Altura Street i
(Street and Number)
FORT PIERCE, SAINT LUCIE GOUNTY, RORIDA .
and this statement is to be taken as my declaration of cititenship, actual legal residance and domitile in the State of Florida.
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(Insert here any peninent facts, such as sale of property or business, or relinquishment of employment
at forme~ domicile, removal of famify to new domicile, purchase of home, etc.) ~
` 1 L~ AND RE
TYflE1.p?
RI ~ '
ST• L.'UCORp VER~FIED
R~
i'~3~~ :13 .
,69 ~pN ~ 6 ~ ~
i~ OITRAS ~
R R COVRT:
~`ERK C1RCU1?
I RJRTHER CERTIFY that 1 will oompty witfi all other requitements of s layal resident of this State.
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1 FURTHER CERTIFY that 1 have no intention to retum to my former domivle, and 1 intend to remain in FORT
PIERCE, SAINT IUCIE COUNTY, FtORIDA, pe~menently.
• .r:,, ,
zt`~r ~~<.~-a.
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~ HARRILTT M. SULLIVpN
J• •~L =f• I..{' ~/ti1e)
i ~ ~ ~ . . . .
t~f ~ ~ 750 Altura Street
. . -'~.,•`_-_r; • .C !i' (Addres:)
4.. A•~:t,` t
Sworn to and s~bsuibed before m~ this 16 t h ~y of ~J anu a ry , ~ 9~q
ROC ER POITR/1S ' . , . , !
CLERK CIRCUR COURT Notsry Pubiic ~
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~Y ~ O.C. My Gomrnission ~xpir~s ~
(T~ b~ ~x~arNd i~ dvplicah awd oei~iwai fif~ wid~ CiKk Cie~aiM Gwt, and drplieat~ vv&h T~x A~a
~i73 ~1QQ6
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