HomeMy WebLinkAbout2164 . 2a~~98
D~claratio~ ot Do~nicile and Citis~nshlp
TO THE STATE AND COUNTY TAX ASSESSOR. •
51. lUC1E COUNTY, FIORIDA:
This is my detla~ation of Domicile and Citizenship in the Stete of Florida that 1 am filin~ this day in stoordancs a~d
in oonformiy with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal ~esident of - ~~Qto~ - g~ T~ -
(~ity) . (Sfate)
and 1 resided at H~i~ However 1 have chsngal my domidle'
(Streei and Numberj
ro and am and have baen a bons fide resident of the State of Florida since I~ day of
Jtme , 19
TD , and 1 reside at lb~ S.w. Lnltehmrst D~r. . .
(Street and Numbe~~
fORT riERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal ~esidence and domitile in the State of florida.
(Insert here any pertinent facts, suth as sale of property or business, or relinquishment of employme~t .
at former domicile, removal of family so new domicile, purchase of home, etc.)
(Ha~sstead Fsamp~ion~ ~ ~
.
i~liCS~~~~ . .
~ REl~ YERIFi[0.~..{1~.~'
~ ~ ~ ~ ~
201'798
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~ I FURTHER CHtTIFY that 1 will oomply with all other raquirements of a lepa) resident of th1: Stata.
I FURTHER CERTIFY that 1 have no intention b retum to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. g~QO PicCirilli
. - •
(NaR'1e)
(/~C~feSi~
Swom to~we! ~bed before me this T~ ~ day of . 19 70 '
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" i~~~?+++u~ir,, ~;~~s.~
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~ Notary Public
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Sy - _ - D.C. My Gommission expires
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.iwl e.iantl ~ vv~ a.~lc ckwif c~, .na a~plk.~. ,w~l~ Tax A......ra
,'''~~~~~r'r~irrrnS~~~~,~,~o + . . ~ .
600K~ ~iNCE~~. ' b0 ,
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