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Declaration ot Domlcile and Citizenship 1~522~3
TO THE STATE AND COUNTY TAX ASSESSOR,
S1. LUCIE COUNTY, FLORIDA:
This is my declaratio~ of Domicile and Citizenship in the State of Florida that I am filing this day in acoordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes. ,
I was formerly a legal ~esident of Patcho~ue N@W York
(City) (State)
and 1 ~esided at - 15
Florence Street . However I have chsnged my domicile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida si~ce 9th_ day of
Febr~.~ary ,~9~2., and I reside at ~37 Melt~n Drive
(Street a~d Number)
FORT PIERCE, SAINT lUC1E COUNTY, RORIDA
and this statement is to be take~ as my declaration of citizenship, actual legal residence and domicile in the State of Hotida.
(Insert here any pertinent facts, such as sale of property or business, ar relinquishment of employment ;
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at former domicile, removal of family to new domicile, purchase of home, etc.) ~
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Entering children in school.
E .~~.1 :,t~J itE(:~~:OE~J 1
Si. LUC1~ COUNT~. FL•1J ~
~~coao vERiF 1'75~28 ~
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;.U~ : ~3 Z8 ~~1 Z:37 ~
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I` tjt]L1~ (~~.Ii ~ f~FIJ
;LERK CIRCUiT COURT
! FURTHER ~HtTIFY that I wil) oomply with all other requlrementa of a(egal resident of thia State. ~
I FURTHER CERTIFY that I have no intention to retum to my former domi4le, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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(Name) Robert E. Petrillo
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,
_ (Address) ~
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Sworn to and subscribed before me this 28th day of Febr~~ry , 19~4.
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R~OGER ~ POt1RxS
~ ELERK CIRCUIY 40URT Notary Public ~
. ~ . - • -Y : ~
. R
gY D.C. My Commission expires '
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~(Ib~6i ~c~tid in dupliuM snd ori~inal filed with Cl~rk Cjrcuit Cou~i, and duplicat~ witb Tax Ast~stoc.)
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Na. 19
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