HomeMy WebLinkAbout2368 1'74'798
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Declaration ot Oomicil• and Citisenship - ~ ~ - ~ -
TO THE STATE AND COUNTY TAX ASSESSOR,
Si, lUC1E COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida thst 1 am filing this day in aooordanoe and
in oonformity with Chapter 222. Section 222.17, Florida Statutes.
I was forme~ly a legal resident of ~epmOre New York
(Ciy) (State)
and ~~esided at -~69 Tremaine Ave. . Howevar I have thanged my domicjle
(Street and Number)
ro and am and have been a bona fide resident of the State of Florida since 12 day of
December , 19 69, a~ ~,~ide at 182~ A Gulfstream
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORtDA
and this statement is to be take~ as my declarafwn of citizenship, actual legal residente and domicile in the State of Horida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, remaval of family to new domicile, purchase of home, etc.)
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FILED ANO RECORDED
ST. LUCIE COUNTY. FLa.
~F. co~n v= ~iFiEo
. l~'4`798
' '69 FEB I 4 P!~ I: Z~~~ .
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E ~?ocr_R ~ oiTRas
f CLERK CIRCUIT COURT~ ;
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1 RIRTHER ~ERTIFY that 1 will oomply with all other requiremenis of a(egal resident of this State.
I FURTHER CERTIFY that I have no intention to retum to my former domicjle, and I intend to remein in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~/~L~p _ Q y, ~ '
~~C/?J .O l~tJ
r BSTHBR S. WILLIAMS ~
~ , . (Name)
~ - I .
~ . 1821 A Guifstream
-
~ . (Address)
" ' ~ -
69
~ ~ Swdrr~io ~nd subsuibed before me this 14th day of Februar y , 19
, . .
. ~ .
Rovc~ romu?s
C~CUiT COURT Notary Public
.
By D.C. My Gommission expires
1T~ bi ~e~e~ in dvpiieal~ aed eri~inal fil~d will~ Cl~lc prwi~ C~ae~f, and dvplieaN wilb Tax A~e~a
° R 175 i~aLE2364 - ~
600K
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