HomeMy WebLinkAbout0095 Declaration ot Dornicile and Citizenship
TO THE STATE ANO COUNTY TAX ASSESSOR. ~~v,~I ~
Sl lUC1E COUNTY, fIORIDA
Th~s ~s my declaration of Dom~c~le and Citizensh~p in the State of Flonda that 1 am f~f~ng this day ~n accordance and
in conformity with Chapter 222. ~ction 222.17, Florida Statutes
;
I ~vas~formerly a legai residem of i~u~1B~ xBX Jeree7 `
(City) (State) ~
~
and 1 resided at ~ 4 Memphia AY6IIti8 However 1 have changed my domiCile ~
(Street and Number)
to and am and have been a bona fide resident of the State of Fl~rida s~nce ~ at day of
Soptember .~9. 7~, and 1 reside at Rt. 2 BQIC__'~~1Q1_-St_______
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement ~s to be taken as my declaration of citizenship, actual legal res~dence and domicile in the State of Florida.
(Insert here any pert~nent facts, such as sale of property or business, or relinquishment of employment
at former domic~ie, removal of famity to new domicile, purchase of home, efc.)
~ k
To enroll children in achool. ~ '
Charlee - 12
Deborah - 12 •;E~S~
F~~'~ S
f «`~~;t 4
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Sj . Rp , _ ,,~j v '
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R``~' ,a ~3 aH
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I FURTNER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that 1 have no intention to return to my former domi~ile, and 1 ~nterd ta remain in FORT
PIERCE, SAtNT LUCIE COUNTY, FLORIDA, permanently.
r
~ ~r~~'z- - - ~
(Name) ~
Grnce Rusignuolo
Rt. 2 Boz 3501-G
(Address)
Svvom to and subscnbed before me th~s _ day of _ ~G~Ob6r
19
• R04ER IlOITRAS _ - - -
KZ1kCU1T COURT_ . Notary Publ~c
By - ~<<`~_ _ D.C. AAy Commiss~on expires _ _ - _ - -
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, .
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(To b~ execut~d in duplicats and origina) filed with Cltrk Grcuit Court, and dupliut~ with Tax Assessor.) ~
BOOM 1~U fACE ~ ~S
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