HomeMy WebLinkAbout2548 Qeclaratio~ ot Domicile and Citisenship 2 p 5 9 0 9
TO THE STATE AND COUNTY TAX ASSESSOR,
51. WCIE COUNTY, FlOR1~A .
Th~s ~s my declaration of ~omiute and Cit~zenship in the State of Florida that I am fil~ng this day in accordance and
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;n conformiry with Chapter ?24, Section ?22.17, Florida Statutes
1 was formerly a legal ~e:~de?,r of_ Summit l~ew J ersey
(Ciy) (State) ~
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and I resided at 3 ROtBTy DZ'ive _ Nowever 1 have changed my domicile
(Street end Number)
~o and am and have been a bona fide resident of the State of Florida since 23rd day of
December ,~9_69 , and I reside ar . 4056 Greenwood Drive
(Street and Number)
~ORT f1ERCF, SAIN? LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida. ~
(Insert he~e any pertinent fads, such as sale of property o~ business, or relinquishment of employment ~
, ;
at former domicile, removal of famity to new domicile, purchase of home, etc.) ~ ~
205909
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~ I FURTHER CERTIFY that I will oomply witi~ all other requirements of a legal resident of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domiGle, and 1 intend to remain in FORT
~ PlERCE, SAINT LUCIE COUNTY, FLORtDA, permanently. ~
a~va.~.,~-r ~ri~,~¢Zt~i~a
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~ SALYATORE COSTABZA
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~ ~ , . ~~r~r~~ (Name)
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= ` :~~,v;'~'~+'" ~~i
~ ~ n+~y-.k~I~ ' 4056 Greenwood Drive, Ft.Pierce,
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_ - ' " 4; ~ ' i' o : (Address) OZ'~-
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~'~~~:~1~'3~~n'bed before me this _ 12 th day of __Y8Z'Ch- , 19 71 .
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:3 CLERK CIRCUtT COURT Notary P~blic
~ By - ~ D.C. My Commission expires _
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' (To b~ ~x~cut~d in dupliut~ snd oriQinal ~il~d wifh G~rlc Grcuet Courf, and duplisst~ witli Tax AssKSOr.)
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