HomeMy WebLinkAbout0120 Declaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FIORIDA:
This is my declaration of Domicile and Citizensh~p in the State of Florida that 1 am fili~g this day in accordance a~d `
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in conformity with Chapter 2?2, Section 222.17, Florida Statutes. ,
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Free rt I.on Island New York
I was formerly a legal resident of -
~~;ty~ (State)
120 Lexin ton Ave. . However I havechan ed m domicjle
and 1 resided at - _ _ - 9 Y
(Street and Number)
to and am and have been a bona fide resident of the State of florida since 21St day of
~n-- . 19---, and I reside at ~ '
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FIORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of famity to ~ew domicile, purchase of home, etc.)
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(Homestead Bxemption) ~
F~~ED~ AND RECORDED`
ST, lUC1E COUNTY. FLA.
F~~ ~nF~ ~~lFlEO '
~lo ~ ~30 ~
~ar~ s a~ ~o : sT
~
~ o~.~~: = t~i~n;;g
CLERK ~~RCUIT COURT'
1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State. ~
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~ I FURTHER CERTIFY that I have no intention to return to my former domicjle, and 1 intend to remain in FORT ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. Frallk MOOtSt]eZ
~ (Name)
~ ~ ' • ~
~ . ~ = ~ ~ 509 Ulrich Rd. ~
~ (Address)
~ • ~ ~
~ ' ' Sth anaury ~q 70
~ ' Swo~n tri ~nd subscribed before me this day of -T , -
~ . =
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~ ROGER POITRAS ~
~ C K CIRCUIT COURT Notary Public ~
~ y
gy ~ D.C. My Commission expires ~
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(To bs exearted in dupliute snd original filed with Clerk Circuit Court, snd dupliute with Tsx Ass~sso~.) ~
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~ BOOK1~~ PAGE
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No. 13 ' - • .
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