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Declaratlon ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, ,~9D~
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Sj . IUCIE CCUNTY, FLORIDA:
This is my declaration of Oomicile and Citizenship in the State of Florida that 1 am filing this day in accordance an~
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of ~tooheateT _ _ _ _ __N. _Y.__ ~
(City) (State}
and 1 resided at 211 ~a~3~ ~IIe However I have changed my domiCGle
(St~eet and Number)
to and am and hav~ been a bona fide resident of the State of Florida since 9~9~20~T0 day of
1
- . 19_ , and 1 reside at _ 3~~ $p• Fsds~e~?3.-A3~bata~-- -
(Street and Number)
PORT PIERCE, SAINT LUCIE COUNTY, FIORIDA
and this st~tement is to be taken as my declaration of citizenship, actual legal residence and domicile in ihe State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or reiinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Placing chfld in pnblic achool ' ~
Vslerie Jtme Fonti
FILED ANO RECORDE~~
- ST. LUCIE COUNTY. FLA. ~
RFCORD VER{~'~EQ
1J0
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'tQ SfP 22 PM 3:29 i
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ROGEit r'UITRAS ~
' CLERK CIRCUIT COURT'
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~ I FURTHER CERTIFY ihat I wil) comply with all other requirements of a legal resident of this State.
1_FIiRTHER_ CERTIFY ihat I have no intention to refum_ to my former domiGle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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(Name) ~els A. Fonti t
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. ,,.6~V~i~ ~f~ 61~~ auburibed before me this - 22nd - _ day of --__S~~l~~`eT _ . _ 19_TO .
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- ~ ' ~ f~URT / - - ----Notary Publ ic - - -
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By ~ F ~ L LL' D.C. My Commission expires _ _
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RO ~i i~U~d Ie duplicat~ •nd oripinal fil~d with Clerk Grcuit Court, and dupliut~ with T~x Ass~ssor.)
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