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Declaratlo~c o~ Domicile and Citiz~nship
TO THE SYATE AND COUNTY TAX ASSESSOR: '~1:133g ~
Sl. lUC1E COUNTY, FIORIDA:
This is my declaration of Domicile a~d Citizenship in the State of Florida that 1 em filiny this day in acoordance and
~n confo~mity with Chapter 222, Sectio~ 222.17, Florida Statutes. • .
1 was fo~merly a legal ~esida+nt of N~rth~rsle _ N. J.
. - (CitY) (State)
and 1 resided at lU5 Li~/i1~s4one St~'eeZ Flowever 1 have chanyed my domitile
(Street and Number) i
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ro a~d am and have been a bena fide ~esident af the State of Florida since `~e_ Z~__- ~ - day of j
' i
19?1 , and 1 reside et ~23~Iroquois A~renne '
_ (Street and Number)
i
FORT PIERCE, SAINT tUC1E COUNTY, RORIDA ~
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and this stateme~t is to be taken as my declarotion of citi=enship, actual legsl rasidence and domitile in the Staro of Horida.
(Insert her~ any pertine~t facts, such as sale of property or twsineu, or ~elinquishment of employment
at former domicile, removal of family. to new domicile, purchase of home, etc.) ,
Sstwblishina reiidenc~ ior ha~estead eze~ption
fILfO ~tMO RECOROEe
tT~ I~IOCfR PO~ITU~StA
Ci£it~ CIACUIT COYII
RECORO vEa~f~f0
.Iw 11 iA !9 ~M'~ I
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2~1338
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I FURTHER CERTIFY that I will oomply with all other requireme~ts of a le~al resident of this State. ~
I FURTHER CERTIFY that I have no intention to return to my formec domicjle, and 1 intend to re in in FOR~
PiERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
.
0
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(Name) V csnt C~rbasi
(Address)
Sworn to end subscribed before me this ~ day of _'~e , 19 T1 .
to:i.:iitlu,~ ' ~
ROGE~~' j ~
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- C1~fG~~.1~~ - - Notary Public
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By D.C. My Commission expires
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Ro b~ ~ and ori~inal filw! wiH~ Ci~rk Circuh Coue~, and duRllcah with Tax As~wser.) ~
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BooK 1y~ 1454 ~
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