HomeMy WebLinkAbout1431 O~alaration ot Oomlail• ~~d Citis~nship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LtK1E ~OUNTY, FLORIDA:
This is my detle~ation of Domicile end Citiz~nship in th~ Stet~ of Florid~ that I am filinp this day in ~coordanu ~nd
i~ confo?mity with Chepter ~22, Sectio~ 222.17, Flo~ide Stetutes. ~
1 was fo~merly a leqel resident of ___~~BtO Beach Florida _
_ (Cty) (Sta») ~
and I resided at 646 CBmeliB I~BIIe F{~„revsr 1 have char~yed my domidla
(Sinet and Number) ~
to and am and have been a bona fide ~e:ident of the Slate of Florida since 15 th day of
Au~ust , 19 ?0, and 1 roside at 2609 H3ghlaIId Blvd. ~
_ (Street and Numbsr) ~
FORT ~IERtE, SAINT LtIC1E COUNTY, lLORI~A
and this statement is to be taken as my decla~ation of citizenship, actual le~a) residenoe a~d domicile in ths Stats of Horida.
(Insert here any pertinant 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.)
(Homestead Eaemption) .
. FIL:ED AND RECORDEQ~
ST. t,UCIE COUNTY, FLA:~
R~CORO YERIFIED
19`739~'
't0 AUG 19 AM 10: 56 .
~ ROGE?~ POITRAS
I CLERK CIRCUIT COURT~
~ .
~
1 FURTHER CERTIFY that I will oomply with all other requirements of a lepal resklent qf this St~te.
I FURTHER CERTIFY that I have no intention to retum to my former domicGle, and I intend to ~emsin in FORT
PIHtCE, SAINT lUC1E COUNTY, FLORIOA, pe~manently. GerhaZ'd Buh~'
X
(Name) ~
z
~ _
(Addres3)
~ Sworn to and subscribed before me this 19th dsy of Aug118t • ~ ~q 70
.:•r: . .
i
` ~oU ~ Notary Public ~
- ;tF~
By , ~z ~.C. My Commission txpir~s
• =~R1=. ~ • Q ~ -
- ~ t3` _ • _
- : ~ ~
_ ..T , ~ ~
;a~ ~ ' and KiDMaI fil~d w11h Cl~elc Wwiit Cw~1, and d~liaN whh Tax A~a
, 1 ~
v` . 0 R
SZ' 600K
~ 186 ~ 14z9
No. u '~~~tts`rl~,:::~+~ti~~t, .