HomeMy WebLinkAbout0934 Declaration ot Oo~ntcite and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~
ST. lUC1E COUNTY, FIORIDA:
This is my declarotion of Domicile end Citisenship in the Stats of Florida thst I am fllinq this day in aooordanw and
in oo~formity with Chapter 224, Section 222.17, Florida Statutes.
I was forme~ly a legel ~esident of NeM YOiIt New York
' (Gity) (Stste)
~
end 1 resided at 4332 Vireo Ave. ,~WeVef ~nqed my domwle
(Street and Numbe~)
ro snd am a~d have been a bona fide resident of the State of Florida sinoe 8th ~y ~
4ctober ,~q 69, a~ ~ reside at 45 Whi~ r+ng r,r•••r vill~zg~
. (Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declarotion of citizenship, actual legal rssidenoe end domitils in the Staro of Horida.
~
(Insert here any pertinent fads, such as sale of property or busineu, or relinquishmant of employmsnt
at former domicile, mmovat of family to new domicile, pu~chase of home, etc.) f
` (Bstablish Residence)
pND RENORDE~.. ~
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CLcRK CiRCU1T COURT
1 RIRTHER CERTIFY that 1 will oomply with all other requiremenri of a leyal residsnt of this State.
I FURTHER CERTIFY that I have no intention to retum to my former domivle, and 1 intend to ~emain i~ FORT
PIERCE, SAINT WCIE COUNTY, fLORIDA, permanently.
~ j~ Bmoa B. Grinm
~ ~
- (Name)
_ , ' 45 WhiSDeI3OR Cteek Vlllz~e ~
~ ~ (f?ddress)
, • .
~ . .
~ ' 19th
~Sworn'td'ahd 'subxribed before me this day of J~~arY , 19~~.
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.'r~; ~ ~RCUIt/// sssCOUR Notary Public
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gy D.C. My Commiu'wn expires
(To b~ ~x~cut~d in dupliut~ and e00 n~ ~if~d PAwGitEh q~M~ira+it Car~t, and duplka» witb ?ax Ass~a
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