HomeMy WebLinkAbout2169 . Declaration ot Domicile and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR,
51. IUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this dsy in aaordante and
in co~formity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal ~esident of Plainview, Oyster Beg New York
(City) (State)
56 Ridge;Drive
and 1 resided at - . However 1 have chan~sd my domicile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since Ju11e 25 day of
69 ~ 1801 So. Indien River Drive
- _ - _ . l9_-.-and_ l. resisle_a1_
-
_ _
(St~eet and Number)
FORT FIERGE, SAINT LUCIE COUNTY, RQRIDA
and th~s stateme~t is to be taken as my declaration of citiunship, actual legal residence a~d domiale in the State of Horida.
(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, purchase of home, etc.)
Filing for homeeteed eaemption _ l
l~ILE~ AND R6GOR ~
UCtE COUN~~~~'
ST• L VERlF1E0
RECOFtQ
191535
'10 NlAR 26 AM 11: 31
~ ~
aocER Po~Tan
CLERK CIRCUIT COUR~
~
~
~
~
~
~
~
~
I FURTHER CHtTIFY that 1 will oomply with all other requirements of a lepal resident of this State.
1 FUR~HER CERTIFY that I have no intention to return to my former domiCile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, pe~manently.
? G~~,Gtul/
(Name) A na 8a t~burg
J . _ -
? J~' _
45 ~ ~az Kat$burg
~
~ " 26 March
~ Sw~tri~-fo. and subscrii~ed before me this day of ~~q 70 .
.
~ ~ii~;r:~~,•`r
{f?:: ~
~ 't' ~~~~~tL''
• ..c: , .
_J•.',s, r
~ ~
~ . ~'Cp~ ~ Notary Public
~ ; .~~:r
~ t ~ •
. • ~ • ~ Aii1/'~
~ ~ ~ ' f~~Iri/ ~ ~.r. ~ .
~ . ~ Gommission expires
~ ti.~,
.,1•.'Y,4~'-'.m~~;;;.~1~:3.~ ~
't' ..:<??.l~.•
~`•~.~id. ,~N~~ in dupliuN snd ori~ina! Bt~d ~wi~h CIKIc q?a~it Cour~, and duplicah wilb Tax Ass~or.) ,
- +~J
600K~QJ PAGE~r~~
F~n. 13 • - ~ • - . _
~
_ _ . _ . _ _
~
~ .~~r?~~~~~ _
~ ~~~C^,*~*`~ s ~ ~'a t.~. 4 'F`2 ~ ~ ~.~~+L"
_ ~~~2~..v"r°',"^.~~l.~"i7!~2„a.~.`~.. . . . ~