HomeMy WebLinkAbout0807 ~eclaration of Domicile and Cit~zenship 2 p 6 7 7 6
TO THE STATE AND COUNTY TAX ASSESSOR.
Sl IUCIE COUNTY. FIORIDA ~
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This ~s my dectarat~on oi Dom~ale and Citizensh~p in the State of Flonda that 1 am fii~ng this day in accordance and
n conformity with Chaprer ?22, Section 222.17, Florida Statutes
? was formerly a Iega! res~dent of Smithtot~m N e~,1 YoI'k
(City) (State)
~nd 1 res~cled at 153 MBple AVeIItl@ Howevtr 1 have changed my domicjle
(Street and Numbe?)
to and am and have been a bona fide reside~t of the State of Florida since F1TSt day of
August ,974 241 Ferandina Street
- _ . and I reside at -
(Street and Number)
PORT PIERCE, SAINT LUCIE COUN?Y, RORIDA
and this stateme~t is to be taken as my declaration of citizenship, adual {egai residence and domicile in the State of Florida.
(tnsert here any pertinent facts, such as sale of property or bJSi~ess, w reiinquishme~t of employment
at former domicile, removal of family to new domic~le, purchase of home, etc.)
Purchase of Home ( Dec. 15, 1970 ) at 241 Ferandina Street
Fort Pierce, Florida, 33450. t
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(Ho.esteaa ~p~tie~) r~~.EO ~N9 RecdltDEO -
fT. U1C~E COUNT1f F~A.
ROCFR PGITRA= ~ ~
CLERR CIkCUIT COURT
,RECORO VERtF1ED....~r
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s 1 FURTHER CERTIFY that I wil! oompiy wifih 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 domicile, and I ir.:end to remain in FORT ~
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~ ~~ERCE, SAINT LUCIE COUNTY, FLQRIDA, pe:manently. ~
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_ Swom to end wbscr~bed before me this . _ _ day o( _ _ , 19~
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= (~~.1~ ifo~o~l~~ i~ d~pliut~ •nd ~ripinal fil~d with ClNlc Grcuif Courl, •nd dupliut~ witi~ Ta~t Aas~ssor.)
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