HomeMy WebLinkAbout0646 ~eclaration ot Oomicile and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR, '
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Si. LUCIE COUNTY, FtORIOA: ~
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This is my declarotion of Domicile and Citizenship in the State of Flo~ida that 1 am filing this dsy in aooo~da~ce and !
i~ aonformity with Chapte~ 222, Section 222.17, Florida Stetutes.
1 was formerly a legal reside~t of ~Y1gh8mtOII 8eW York
(City) (State)
and 1 resided at 4 Jamea StreBt , Hcvvever I have changed my domicile ~
(Street and Numbe~)
to and am and have been a bona fide resident of the State of florida since 4th day of
Q.~tphgr , 19~~, and I reside at - 118 So 20th street
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and =his statement is to be taken as my declarotion of citizenship, actual legal residente a^a ~+~!'~le in the State of Horida.
qnsert here any pertinent fatts, such as sate of property or busineu, or reiinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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FtLED AND RECOROED? ;
~ ST. LUCIE COUNTY, FLA. ~
Establishing residence ~=~~C0~0 VER~F!ED -
sssz~o
'70 JAt~ I 3 AM IQ : 2 I
; c:OGEr~ : ~~'T~?AS
CLERK CERCUIT COURT~
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I RJRTHER CHtTIFY that 1 will oomply witfi all other req~iremenis of a leyal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiGle, and I intend to ~emain in FO'T
PIERCEt,~S~AtlNF~I~,i~ COUNTY, FLORI~A, permanently. ~
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:'~f~ `1•••••~rf,~f,:~'/.F ~
~ - • . Ma""e~ i
~ _ . _ _ _ _ l~ary A. Bubeldzis ;
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_ ' y - (Address) ;
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~ ~ 5worn to and subscribed before me this 13 ~ day of J8IIUg2"Y , 19~_Q `
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~ ROGER POITRAS '
CIRCU COURT Notary Public ~
~ By D.C. My Commission expires
~ Ro b~ ~x~cubd in duplleab and o~nsl fil~d wkl~ CIKIc prcuit Cour~, and dupljcat~ with Tax Ass~or.)
~ 5001( ~Vz PJ16E
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No. 13 - -
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