HomeMy WebLinkAbout0134 Declaratio~ ot Domicile and Citizenship l~c~~~ ~~~v
TO THE STATE AND COUNTY TAX ASSESSOR,
51. lUC1E COUNTY, FIORIDA:
1
This is my dectaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
in tonformity with thapter 222, Secii~iii i~2 i i,~~::: ~ua .°i:3:uic~.
NeM York City NeK Yort ~
I was formerly a le9al resident of - -
(City) (State)
and I resided at __.2230 _U~i~?lrSit_y__A~e. Br011X However I have changed my domiCile
(Street and Number) -
- t
to and am and have been a bona fide resirlent of the State of Florida since St_h _ day of
March 19 69 and .I reside a~ 220 Gardenia A~e, Ft. Pierce, P~s.
ree an um r .
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual lega~ residence and domicile in the State of Florida.
(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.) ;
i
~1LE~ ~Np RECOROED
, ~E ~QU,iSY. FL~.
ST,'LJ C~ ~C~~~v
_ ? 5 ~~I 11:18
74
~
i , :,S
~ ::p,TR
~ :'r':'~-.i- RT
~ CLERK Ctf<CU1T COU .
I ~
!
s
I FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my fo~r domic,ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~~~D~,~
~6 /
;
FRANjC PIANY s
~
. (Name) ~
~ . - . ~
~ - 220 Ga rdenia A~e, Ft. Pierce, F1.
g ~ ~ ' (Address)
~ •
~ ' TS~ nuar~ .19 ?0
~ ~Swocn to and.su~iscr,ibed before me this Sth day of
v r ~ `1`,, ~
~ - ROGERnPO1T,RAS
~ CLERK CIRCUIT COURT • Notary Public
~ By G'~~ D.C. My Commission expires
~
(To bs executed in duplicate snd origi~al filed with Clerk Grcuit Couet, snd duplicate with Tax Assessor.)
~
n ~ 1~~ ~ti~ 1~~ !
a:~ - $o~x
~
-
. . y_.