HomeMy WebLinkAbout2218 oeclsration ot Dort~icile and C~ti:enshlp 1~4 ~l
TO THE STATE AND ~OUNTY TAX ASSESSOR,
Sj. IUCIE COUNTY, FLORIDA:
This is my declarotion of Domicile and Citizenship in the State of Florida that i am filin~ this day in accordanoe and
in conformity with Chapte~ 222, Section 222.17, Florida Statutes.
New York Citv New York
1 was fo~merly a legal ~esider~t of
' (City) (Stats)
and 1 resided at 110 » 28 63zd Road Forrest Hills . Howevsr 1 hsve charped my domic~le
(Street and Number)
b and am and have been a bona fide resident of the State of Florida sinoe 3lst ~day of
May _ ,~9_5~, and I reside af 1405 Cit ru~ AvenLe
(Sheet and Number)
FOR? M~CE, SAINT LUCIE ~OUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pe~tinent facts, such as sale of property or busineu, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of horr~e, etc.)
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1 FURTHER CEftTIFY that 1 will aomply wlth all other raquirements of a(eyal resident of this State.
I FURTHER CERTIFY that 1 have no intention to retum to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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(Miss) Ma""e~Marion Souweine
(Address)
Sworn to and subscribed before me this 12th day of February , ,~q 69 , ~
ROGER POITRAS
C Notary Public
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gY D.C. My Commission expires
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~~dapMcaN snd ori~inal fii~d ~witl~ Cl~k Gra~it Cour1, and dupliue~ wiTh Tax Aa~or.)
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