HomeMy WebLinkAbout1611 Declar~tion ot Domicile and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR, 1~L~~ie
Si. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenahip in the State of Florida that I am filinq thia day in aoao~danos and
i~ oonfo~mity with Chapter 222, Section 22~.17, Florida Statutes.
1 was formerly a legal ~esident of New YOrk City r1. Y.
~ tCiy) (Staro)
and I ~esided at 1470 East 92nd St reet . Hcvvever 1 have chanyed my domic3le
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since J8°• 28 day of
_ , 19122, and 1 reside at Sunchine Mc~tpr G~urt R~,~te 1
~ (Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile i~ the Stab of Horida.
(Insert here any pertinent facfs, such as sale of propery or busineu, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Roland Ellis fiysel to enter public school
` FIIED AND RECORDED
ST. LUCIE COUNTY. FLA.
RECQRO VEAIFI~O
~_1'7431.3
'69 JAN 3 0 AH 10 : I 7
a~
i iti~i~~. f-~~ 1 I~NS
f CLERK CIRCUIT COURT
(
1 FURTHER CHtTIFY that I will aomply with all other requlrements of a le~al rosident of this State.
I FURTHER CERTIFY that 1 have no intention to retum to my former domiGle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
? ~
(Name) Kenn th G. Eysel
• :1:
. . -
~ -t. ' . ~ (Address)
~ . ~ ~
, . 'c-_
S~. ta and subscribed before me this 30 day of January , ~q 6~
' _ • ~ `<<~.~'
- : Cd _
. ' ~ROG~ POITRAS
CLERK CIRCUIT COURT Notary Public
By - ~.C. My ~ommiuion expires
(To b~ ~x~cut~d in dupllcat~ and ori~inal fil~d wjth Cl~~tc qreuM Coue~, and dupllcatt wHh Tax Aa~or.I
sooK 175 ~~E~.b0~8
!io. 13
_ ~ _ ~~x _ _ - 1 s ~'r