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Oeclaration of Domicile and Citisenship '
TO THE STATE AND COUNTY TAX ASSESSOR,
Si. LU~IE ~OUNTY, FIORIDA:
This is my decla~ation of Oomicile and Citizenship in the State of Florida that 1 am filing this day in aooordanos and
in eonformity with Chapter 222, Section 222.17, Fiorida Statutes. ~
1 was fotmerly a legal resident of I'8ke AOpBtCOY1g N@N Jersey ~
(City) (Stats)
Box 493 R. D
and 1 resided at - . However I have chanyed my domicGle
(Street and Number)
ro and am and have been a bona fide resident of the State of Florida since Januarv 10 day of
2729 South Federal Highway
_ , 19 69 , and I reside at
(Street and Number)
FORT MERCE, SAINT LUCIE COUNTY, FLORIDA
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and this stateme~t is ta be taken as my declaration of citizenship, attual legal residence and domicile in the State of Horida. !
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(Insert here any pertinent facts, such as sale of property or business, or ~elinquishment of employment
at former domicile, ~emoval of family to new domicile, purchase of home, etc.)
~tLEO AND RECOROEO
ST. LUCIE COUNTY. FLd.
PE:^(!~tL~ V~RIFiEO
Establishing residency 1,7eJC2~
'69 f E8 2 AN g: 49
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;~oirRas
CLtRK CIRCUIT COURT
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1 FURTHER CERTIFY that I wil) aomply with al) other requirements of a leyal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domic.ile, and I intend to remain in FURT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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(Name) Albert Csontos
• . i
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~ (Address) `
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~ ~ ~ 24 February 69
Swora b qi~d.~subsuibed before me this day of , 19 .
. E,
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ROGER rO1TRA5
C~RK CIRWIT COURT Notary Public
~ By ~.C. My Commission expiros
R~ b~ ~x~erl~d in dupliuN and erioinal fiNd wilb Cl~elc Cira~it Cewt, and dvplieah wilh Ts~c As~~e~a
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