HomeMy WebLinkAbout0162 Declaration ot Domicile and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
This is my declaration of Oomicile and Citizenship in the State of Florida that I am filing this day in accordante and
in conformity with Chapter 222, Section 222_17, Florida Statutes.
Lynbroot New Yorlc
I was formerly a legal resident of _ -
(Ciry) (State)
2 70 Barl Ave.
and I resided at _ _ _ _ _ _ - - . However 1 have changed my domitile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since -_2$?h day of
_~luqust 19 69 , and I reside ar 254 Soli~a Drive
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaratit~n ot citizenship, act~al 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.)
~stablishing residence F~~EO qN
ST,' ~UC1E ~DUE1TORpEp:
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~l~ J~,l S P~~11~4;~~~~
~2• ly
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I FURTHER CERTIFY that I 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 former domiCile, and I intend to remain in FORT ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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' ~ ~ r . ~ 1 ' -~aY'-~/ `
'
~ `J _ A1 red O(Na Geisler
.
~ • ' ~ ; (Address) ~
~ -
~ ~ Sth January 70
~ . Swo~n~ to and subscribed before me this day of , 19 .
~ -
~
~ ROGER POITRAS
~ LERK CIRCUIT COURT ' Notary Public
~ ~~~.G~ ~
~ By D.C. My Commission expires
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(To bs sxecuted in dupliate and original filed with Cle?k Grcuit Court, and duplicste with Tsx Assesfor.)
'-k:
BOOK 1~2 ~~~E 161 -
; No. 13
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