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Declaratio~ ot Domicile and Cltizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
S~. IUCiE ~OUNTY, FLORIDA: ~
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in acoordanoe and
in conformiy with Chapter 222, Sectio~ 222.17, Florida Statutes.
I was formerly a(egal ~esident of NeN Yorl~ City _ NeM York
(City) (State)
i
35~31 8Sth street St. Jackson Hgth +
and I resided at _ - . Howevef I have changed my domic~le
(St~eet and Number) •
to and am and have been a bona fide resident of the State of Florida since - 2?tb dsy of
APr11 _ ,~9~9 and I ~eside at ?58 ~~at Street Port St. Lucie _
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA ~
and this statement is to be taken as my declaration of citizenship, actua) legal residence and domicile in tlie State of Ho~i~la.
(Inse~t here any pe~tinent fads, such as sale of property or business, or relinquishment of employment ~
at former domicile, removal of family to new domicile, purchase of home, ett.) ,
Establishing residence
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E C~V. ED
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,l~ i 2 ,q~ 18,~,~'8~3
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1 FURTHER CEftTIFY that I will oompty with all other requirements of a leqal resident of this State.
I FURTHER CERTIFY that I have no intention to retum to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
- j~.(l . -
. -r . G!~'l~~vr~ /d-
(Name)
~ . - . a Willism H. Holzapfei
~ ' f_- - ' • ; - .
;;s - : y ~ ~
~ " _ - ~ ' ` ~ < ' ~ (Address)
~ ~ . .•~:.-.._,.•'r;,•~`: -
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~ Sworfi~to arfd subsc~ibed before me this 2 nd day of JaDUil~? ~~q ?0.
~ -
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~ ROGER POITRAS
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~ K CIRCU~COURT Notary Public f
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~ ey D.C. My Commis~ion expires
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~ Ro b~ ~x~cut~d in dupliuh and ori~inaf filed witb Clerk Grcuit Coue~, snd dupliuh wHh Tax_As~uor.)
~ BOOK 1~7~ PAGE J ~
~ No. 13 - • -
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