HomeMy WebLinkAbout2787 Declaration o! DomiCtle and Citizenship
i0 THE STATE ANO COUNTY TAX ASSESSOR,
Sl. lUC1E GOUNTY, FtpRIDA ~4~1
This ~s my declara?ion of Vom~cile and Citizenship in the State of Florida that I am fil~ng this day in accordance and
~n conformiry with Chapter 222, Sectio~ ?22.17, Florida Statutes
~ ~~~u~ -
1 was forme~ly a legal resident of _ZR.f~~L~ -
(State)
and I resided atp~~~ ~L~~ri.~tJ'(,I~~~i~i~6-1i,~.E- However 1 havechanged my domiti~e
~
(Street and IVumber~
to and am and have been a bona fide resident of the State of Florida since _ day ot
,
19~~ and I resid~ at b~. ' J=_~~J
~ ~ (Street a~d Num r)
FORT PIERCE, SAfNT LUC1E COUNTY, FLORIDA
and this statement is to be taken as my dec~aration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, suc1~ as sale of property or business, or relinquishment of employment
at former domicile, remaval of family to new domicile, purchase of home, etc.)
lL4 -
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FItEO ANt~ RECOROEO
ST. LUC1E ~QUKTYtRI,~.
•ROCER POITR~RS
f2~ - RECO ORVERR
Ifr C~~~~~
Quc 19 IQ 2s ~i'T I
I 214~1 ,
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
! FilRTHER CERTIFY that 1 have no intention to return to my former domic,iie, and 1+nfend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, pe~manentty_
~ ~ -
~ ~
, (Name)
Jndit6 A. Stopkowitz
~ - ~o r~~~ .
~ _ (Address)
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~ 1 ~ ~
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~ Sworn t a ~ ~ ribed befo~e me this - - ~ - - day of ~ 19~.
o ~Y~ ~
~ . . ~
~ _ : ; :
~ Roa~e Panws - - -
~ CLERK CIRCUIT COURT Notary Public
~ _ D.C. M Commission ex ires
~ aY J - - - - - y P
~ ~
~ (To b~ ~xecut+d in dupiicats and ori~inal fil~d witH Cbrk Circuit Court, and dupliuM with Tax Asses~or.1 31
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i94 2785 i
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