HomeMy WebLinkAbout1667 Mala~atlon ot Don~iaif~ and CKIsMShlp
TO THE ST/1TE /WO COUNTY TAX ASSESSOR. 2~~,~2
Sl. LUCIE GOUNTY, FLORIDA:
This is my decla~~tion of Domicile ~nd Citiun:hip in tM Stet~ of Horid~ th~t I~m fllinq this day in sooo~dano~ and
in co~formiy with Chapter 222, Settio~ 222,17, Florida Statut~s.
I was formerly a Ipal ~esid~nt of B~Y 3 7 1 e I.. I. N. Y.
(~ity) (Sfah)
end ~ residad at T 31 Jefferson Ave.
~ (Street and Number)
ro and am and have bee~ a bona fids rosident of th~ Stah of florida ~inos APril day of
1208 South 12th Street
, 19 ?0, a~d 1 rosids d
(StreQt and Number)
fORT M~CE, SAINT ~UCIE COUNTY, RORiOA
and this statement is b be taken as my ~dedaration of citi~enship, actual Ipal reside~oe ~nd domiale in tha Stste of Horida.
(Insert here any pertinent facts, such as sale of property or business, ar relinquishment of ~mployment ~
at fo~mer domicile, removal of family to new domicil~, purchass of horne, eic.)
Homeatead
~ FILEO AND RECpRpEo ~
tT. WCIE COUNTY FLA.
ROCEIt POIT~IA=
CIERK CIRCUIT COWIt
RECORO YERIFIEO~~
J~ 18 3 s~ PM'TI
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~ 1 RJRTHER CERTIFY that I will comply with all otF~sr roquir~b of a te~aal raid~t of thit State.
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~ 1 FURTHER CERTIFY that I have no intention to ~eturn to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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~ to.ei~d,~stribsd before me this y .
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