HomeMy WebLinkAbout1640 , Oecia~ation o! aor~niail~ and Citiz~nship ;
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TO THE STATE AND COUNTY TAX ASSESSOR,
51. lUC1E COUNTY, FIORIDA:
This is my declarotio~ of Oomicile and C+tixenship in the Stete of Flo~ids that I am filing this day in aawdencs and
~n co~fo?mity. w~th Chapter 222, Section 2?2.17, Florida Statutes.
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1 was fo~merly a tegat ~es~dent of N~t~_XQ~lt-- - ~ _ _ _ ~Ie~7Gnrk
(City) ~ (Staro)
and 1 ~esided at Nassau_Hospital~ Mineol8, Nex York _ . However 1 have changed my domi~ile
(Street and Number)
ro and am and have been a bona fide resident of the State of Florida since day of
, 19 and 1 reside at po="t St. Lucie, St. LuCie County~ Florida
(Street and Numbe?)
FORT r1ERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida. .
(Insert here any pertinent facts, such as sale of property w business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.). I ha~Pe bought pTOpe~'Ey
through General Dev. Corporation in September 1q70. Accountirig number 8192254 anci plan
to reside in Port St._Lucie upon retir~ment. -
filEQ AND RECOROEp
- :T. LUCIE COUNTY flA,
ROCER POITIIAi
CIERK CIRCUIt COURT e~
~ RECORD YERIFtfD ~
J~ 18 II 31 AM'~I
2a3451
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~ ! RIRTHER CERTIFY that 1 will comply with all other requirements of a leqal resident of thia State.
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I FURTHER CERTIFY ihat l have no intention to ret~m to my former domi~ile, and I intend to remain in FORT
PlERCE, SAINT tUCIE COUNTY, FIORIDA, permane~tly. ~
~ A. I.IHIySFJEIa, I.TC, MC . 3_~~
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~ Mame)
~ presently: 130th Station Hospital, APO N.Y. 09102
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p~*t S* .~itici4, St. L~o~e 6eunty,
~ (Address) Flo!'idb
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~ Sworn to and subscribed before me this ~+th dsy of , 19~Q._.
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~ Roa~e romu?s SL ~
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~ CLERK CIRCUIT COURT Notary Public
~ 8y D.C. My ~ommission expires Indeli*+ita
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~ (To b~ ~xscut~d in duplicab and ori~insl fil~d witb Cl~rk Ciraiit Cou~f, and dupiiest~ with Tax Ass~s~or.)
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