HomeMy WebLinkAbout2754 D Iaration ot Domi ile and Citizenshi ~
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TO THE STATE AND COUNTY TAX ASSESSOR, i
Sl. IUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State oi Fiorida that I am filing this day in accordance and
in confo~mity with Chapter 222, Section 222.17, Florida Stattttes.
I was formerly a legal ~es~de~r of Johnsonburg New York _
(City) (Stab)
and I ~esided at ~ P! BOZ 64 1~io,,,~ever I have changed my domici~e
(St~eet and Numbe~)
to and am and have been a bona fide ~esident of the State of Florida since 15 th day of
_ Qctober ,~q
62., and I~eside a* 601 Sea~lay Drive H 5
(Street and Number)
fORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence anct ~~micile in the State of Florida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purcFiase of home, etc.)
Eatablishing residence u~
pND Rc CORp~
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LUC .
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I FURTHER CERTIFY that I will comply with all other reguirements 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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~ (Name)
~ : ohn x. Burdeloqv
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. _ ~
: (Address) i
- ~i,.:..~Nr~i.,~~ ;
r'i ~ ) ' ' ~ '
~ 13 y February 7~ ~
y ~wosA to
a~¢~~ubxribed before me this da of , 19 . '
~ -~L- ; ' . ' ~ - _ -
~ c ~ aI ' `P~I~ftAS
~ , CI.~RIC CIR, ~OURT Notary Public
'~1 ' ~
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By ~ O.C. My Commission expires
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~ (To be ~xecut~d in dupliwt~ and ori~inal fil~d witl~ Clerk Circuit Cour~, and dupliu» with Tax Ass~s~.)
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~ y~ 13 BooK182 PA~2749
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