HomeMy WebLinkAbout1661 Oeclaratio~ ot Domicile a~! Citisenship
184538
TO THE STATE AND GOUNTY TAX ASSESSOR,
51. IUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship i~ the State of Florida that I am filing this day in soootdanos and
in oonformity with Chapte~ 222, Section 222.17, Flo~ida Ststute~.
1 was forme~ly a legal resident of ~reece Y~rk
(City) ~a~)
and I ~esided at -__$25 En~lish Rosd . However I have changad my domidle
(Strest and Number)
ro and am and have been a bona fide resident of the State of Florida sinee 22nd day of
August ,~9 g9, and ~ roside at 1610 Bahia Drive,
~ (Street and Number)
FORT r1ERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaraYwn of citizenship, actual lega~ reaidence and domicile in the State of Horida.
(Insert here any pe~tinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to ~ew domicile, purchas8 of home, ett.)
Florida residence purchased on July 19, 1969. New York residence
sold on August 22, 1969.
FILEO ANC RECORDEU
~T. LUCIE COUNTY. FLA.
R=Ct?~^ V=r1=lED
184538
'69 Q~T 2 I Ahi I I: 4 0
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CLERK ;,IRC!!iT COURT ~
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1 FURTHER CEitTIFY that i will oomply with all other requiremenri of s le~ai resident of this Stat~.
I FURTHER CERTIFY that 1 have no intention to retum to my former domicjle, and I intend to remain in FORY
PIERCE, SAlNT LUCIE COtiNTY, FIORIDA, permanently.
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- 1610 Bahia Drive
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~ - ;„t : Fo rt Pie rce, Florid a
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; ~ _ . (Address)
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. r,,,, ~ ~ ` = Octvber 69
"5wo~n to and subscribed before me this day of ~ , 19 •
ROGER POITRAS
CIRCUR
OU~ Notary Public
By D.C. My Commiss"wn e~cpires
(To b~ ~x~cvt~d in duplicah aed o~inal Al~d wifb Ci~ek qrarH Couet, and dvpliub with Tax As~or.)
B~ 180 ~16~8
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