HomeMy WebLinkAbout0174 t~al~ration ot Domicil• and Ci4iz•~ship ~~3'73
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCiE COUNTY, FIORIDA: _J
Thii is my declaration of Oomicile and Citizenship in the State of Florida that I am filing this day in aooordance and
in conformiy with Chapte~ 422, Section 222.17, Florida Statutes. _
I was forme~ly a legal resident of _~~~C~ - • -
(~Iy) (Staro)
arld 1 resided at ~~V r ~~~V - - - - - . _ ~l4tMAYRr ! 1MY!! ~t~~ R!y ~pmlt~~+!
(Street and Number)
.?~~titrn~b ~ ~y
b and am and have been a bona fide ~esident of the State of Florida sinoe _ dey of
- , 19.~_, and I ~eside at~~ ~QAyS'IyO~P~' ~
(Stteet
snd Number)
FORT MERCE, SAINT LUCIE COUNIY, RORIDA
arxi this stetement is to be taken as my declaration of citizenship, actual legal reside~ce and domicile in the State of Florida.
(Inse~t here any peninent facts, such as sale of property or business, or ~elinquishment of employment
at former domicile, removal of familjr to new domicile, purchase of home, etc.)
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1 FURTHER C'HtTIFY that I will oomply with alt othK requirem~nb of a lepal r~sident of this State.
1 fURTHER CERTIFY that I have no intention to retum to my former domicjle, and 1 intend to remain in FORT
PIERCE, SAINT lUC1E CCrIJNTY, FIORIDA; permanently.
~ -
~a"1°~Joseph~ Kianetz
~ ~~77 /~~y.r,~ a RF a~~
~ (A~ddress)
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Sworn to and wbsc~ilxd before me this a~ dsy of , 19~..
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~ CIRCU~: , ; ~ . Notary Pubtk
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gy ~ ~ ~ ~ ~ ~ ~ O.C. My Commiuion expires _
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Ro b~ `~t;. -t~t•~ fil~d wilb q.ek c•i.c~h co~~f, .~d duplic.~. witl~ Tax A.....oca
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