HomeMy WebLinkAbout1289 Deciacation ot Domicile and Citizenship ~
TO THE STATE AND COUNfiY T~Ut A~~SOR,
Sl, IUCiE GOUNTY, FIORiDA: ~ ~
This is my declaration of Domicile and Citizenship in the State of Flo~ida that I am filinq this day in a~aordancs and
in conformity with Chapter 222, Section 222.17, Flo~ida Statutes. ~
1 was formerly a legal reaident of woOdmeY'e ~ I~or2g Ieland New ~YOTk
(Ciy) (State) '
,
and 1 ~esided at ~ ~ 78 COIIIb AVe . . Howaver I have changed my domiC'tle
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ~ 9th day of a
September 69 3204 Sunrise Blvd. ~
, 19 , ant! 1 reside at 1
(Street and Numbe~) ~
t
FORT PIERCE, SAiN? LUCIE COUNTY, FLORIDA ~
s
4
and this statement is to be taken as my declaration of citizenship, act~al legal residenoe and domicile in the State of Florida. }
(Insert here any pertinent fads, such as safe of properry or busineu, or relinquishment of employment r
at former domicile, removal of family to new domicile, purchase of home, etc.) ;
~
t
~ ~
(Homesteed Exemption)
:
F
FfLEO APJ~ RECORDED
cT, ~i?rt~ rOUtdTY, FL~.
o , v---~~:~?1
- . 19a9a~
' i J t.'~~. g P~'~i 2: 0 I
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- -~~-F:..s
C!.= iir; ~i~Cl.'!T CDURT
i
i FURTHER CERTIFY that I will comply with a!I other requirements of a legal'resident of this State. ~
I FURTHER CERTIFY that 1 have no inteation to retum to my former domiGile, and I intend to remain in F RT
PIERCE, SAINT.LUCIE COUNTY, FLORIDA, permanently. Cl~pn e8 8!;
• ~ - ~
(Name) ~ '
3204 Sunriae Blvd.
(Address)
Sworn to and subsuibed before me this ~th day of ~areh ~~9 70. _
i
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,`'~~t':.~n ~ •~.,~~.f ,
~y;~~..p~,,~'~y,, , .
` ;ZlEf~K'.~IRCUR,~bRT - Notary Public
~
By ~ D.C. My Commission expires
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s~ s':r~ _i 1
'..'C~;~; a~ ;''p:duplicat~ and origi~sl Ol Q with Gtavlc Cirwit Court, and duplicab with Tax Azsessora
. ~,,,r=:~~~~,~~~~~~ BOOK
~ 183 PA~t 1~88
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