HomeMy WebLinkAbout0991 Deciaration ot Domicile and Citizenshlp
~ 188523
TO THE STATE AND COUNTY TAX ASSESSOR,
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51. IU~IE COUNTY, FlOR1~A:
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This is my declarotion of Domicile and Citize~ship in the Stete of Florida thst 1 am filinfl this dsy in aaordana enc4 ~
in oonformity with Chapte~ 222, Section 222.17, Florida Statutes.
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I was forme~ly a legal ~esident of Qicero New York _ :
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. (Ciy) (Steta3 '
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anci i ~aa:~ed at 3531 S 58th COU2't , Hcwever 1 have changed my domicile ;
(Street and Numbe~) ;
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ro and am e~d have been a bona fide :esident of the State of Ftorida since 2nd day of
January ,~q 70 , and ~ re:ida at 115 West Glenn Drive
. (Street and Numbsr)
PORT PlERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domitils in the State of Horida.
(Insert here any pertinent facts, such ai sale of property or busineu, or relinquiahment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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~ Entering children in elementary school '
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~lLED h~~~ RECOROED
ST. LUC1F COUNTY, F~a•
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~ i88523 /
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I LLcpK ~{Rr;,~IT COURT
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1 RIRTHER GERTIFY thai I will aomply with all other requirements of a le~al resident of this State. ~
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1 FURTHER CERTIFY that I have no intention to retum b my former domicjle, and I intend to ~emain is~ fORT ~
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PIERCE, SAINT ll1CIE COUNTY, FLORIDA, p~nnanently. ~
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~ ~ _ , Thomas J. Beranek ~
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~ +?a= - - - . ' , ~ (/~ddress)
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~ . Swcrn to and subscribed before me this 19 th day of y 19~.
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~ ROGER POITRAS ~
~ CIRCUIT COUR? Notary Public . ~
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~ gy ~ ~.C. My f.ommiuion expires
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~ (To b~ ~x~a+t~d in dupliuro and oripimal Rl~d wltb CIQrk Cirwit CouN, and dupliuf~ with Tax Ass~ssor.)
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