HomeMy WebLinkAbout1376 Declaration ot Domicile and Citisenship
-~86~~4
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
This is my decla~ation of Uomicile and Citizenship in the State of Florida that I am filing this day in acaordance and
in conformity with Chapter 2~2, Section 222.17, Florida Statutes.
I was formerly a legal resident of _______KINGSTON NBW YORK
(Ciy) (State)
and I residec! at Rt BOX 80 However I have changcd my domitile
(Street and Number) ~
to and am and have been a bona fide resident of the State of Florida since 27lh day of `
69 1004 Sunrise Hi~d.. Ft. Pierce. Fla. ~
_ SeptemOCr 19--, and I reside at ~
(Street and Number)
FORT PIERCE, SAINT lUC1E COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence 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, removal of family to new domicile, purchase of home, etc.)
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Homestead F1lED ANO RE~pRDEO~
ST, LUC1~ ~OUNTY, ~
f•t_CO~p V~RIFr~p
'69 OEC S j86~~4
~ 10 : 30 _ ~ ~
?,o~;~ ~ - ~°t~
CLERK ~'~ITRqS
~ CIRCUIT COUR~'~
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~ I FURTHER CERTIFY that 1 will comply with al) other requirements of a lega) resident of this State.
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~ I FURTHER CERTIFY shat I have no intention to return to my former domicjle, and I intend to remain in FORT
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PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. SO _/J /y ,~,M
~ C~CLI~' uj~~•~'
~ ~ CARL O./,T~iNSd~i
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, {Name)
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- 1004 Sunriae Bl~d~ Pt. Pierce, Pia.
- ' (Address)
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~ • 7 . 69
- = Sworn to andivbsctibed before me this Sth day of Dece~lblt ,~q .
~ ~ , M
i~Eit'~HRAS
~ . ~CIRCUR COURT Notary Public
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gy p.C. My Commission expires
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- Qo bs sxecuted in dupliuM snd original filed with Clerk G~cuit Court, and dupliu» with Tax Ass~stor.)
aooK~81 ~E1376
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