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DeGlaration ot Dot~iclle and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIOA: .
This is my declaration of Domicile and Citi=enship in the State of Florida that 1 am filing this day in accordance and
im m~formity with Chapter 222, Section 222.17, Florida Statutes.
New Heven Connecticut
1 was formerly a legal resident of - -
(City) (State)
488 Woodwgrd Avenue
and 1 ~esided at However I have changed my domicjle
(Sireet and Numbe~)
to and am and have been a bona fide resident of the State of Florida since December 3 day of
c/o Quinto Menchetti
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62, and I reside ar 4003 Avenue R- Ft Pierce , Fla .
(Street and Number)
FORT PIERCE, SAINT LUCIE tOUNTY, 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 peninent facts, such as sale of property o~ business, or relinquishment of employment
at former domicile, removal of family to r.ew domicile, purchase of home, etc.)
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Placing child in public school - Pasquale i~sas~~tf Carfora ~
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FIlEO'AND RECORDED~
- ST. LUCIE COUNTY; FLA.' -
RFCORD VERIfIEO
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; 69 DEC 5 AN 10 3
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~ re~E~ :~04TRAS ;
; CLERK CIRCUIT COURTI
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I FURTHER ~ERTIFY that I will comply with all other requirements of a legal resident of this State. ~
1 FURTHER CERTIFY that I have no intention to return to my former domiqile, and I intend to remain in FORT
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= PIERCE, SAINT LUCIE COUNTY, FLORIDA, pe~manently. ~
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~ (Name) Nathetl ; Menchetti ~
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(Address)
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~ Sworn~to.and'subscribed before me this 5th day of December ~~~9
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Y - ~ M/V~ rVl ~ RMi ~
. CLFRK CIRCWt ~IiRT Notary Public
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~ By O.C. My Commission expires
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(To b~ ~x~oul~d in dupliut~ and ori~inal filed with Cl~rk Grcuit Court, and dupliut~ with Tax Ass~or.) i
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