HomeMy WebLinkAbout0990 Declarat:an o! Dornicita a~d Cit~ze~ship
~ j0 THE STATE ANO'COUNTY TAX ASS~SSOR, '
Sl, IUCIE COUNTY, FLORI~A: ~9~
This is my declarat~on of Oomicite and Citizenship in the Stat• of Florid• th~t 1 am filinq thit dsy in ~co~d~nt~ •nd
~n oonfo~m~ty with Chapter 222, Section 222.17. Florida Statutes.
1 was formerly a leflel re:ident of Falls ChurCh ' Ve.
(Ciry) (Sta»)
snd 1 ~esided at _ 3302 Pottertown Dri~e ,~~vK I hav~ ct+anq~d ~+ny domitilt'
(Street a~d Numbe~)
ro and am and have b~en a bona fide resident of the State of Florida sir?o~ 30th day of
October ?1 229 NE Airoao Blvd .
_ , 19 , and 1 r~side ~t
Port St . 1'ucie ~reet and Number)
FORT PIERCE, SAIN? LUCIE COUNTY, FLORIDA
and this stateme~t is to be taken as my declaration of citizenship, actual le9al residence.nd domicil~ in th~ Sr~ro of Horida.
(Insert here any peninent facrs, :ush as sale of property or businsss, or relinquishnwnt of ~mploym~nt
•t form~r domicil~, nmov~l of famify to n~w domicil~, purch~s~ of honw, ~tc.) -
~Establiaring reaidency .
fkE9 AND RECO!~
fT.lYC1E CatINT1 F1~
ROCfR POIi~AS
CtERR CtACtlt~ COINIt
. IlECMt~ YEN~FIEO
_ l~ou 11 1I ~o AM'1~
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I FUR7HER CER71Fl( th~t 1 will oomply with all oth~r ~~quir~rwnts of a lpal t~id~nt of this Stat~.
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~ 1 FURTHER CER7IFY that 1 have no intention to nturn to my former domic~:s, and 1 int~nd ta r~main in fORT
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. PIERCE, SAINT IUGE COtJNTY, F10R1DA, ptrman~ntly. ~
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- ~N„T,e~ Herman . Croom
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~ 22nd No~e~cber , ?1
= Sworn to and subx~ibed befor~ n» thi~ d~y of 19 .
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ROGEit~POjT,j~~' ' , =
- CIFRf( CIR~~C~~Rf':r"~- Notary Public
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= ey ~ _s t~ O.C. My Commi:sior~ expiros ~
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~r Qo b~ ~xicy3~d at~ aed ori~inal Ft~d witb Cl~rlc Cirwit Co~+~t, ~ed d~+plicat~ w+th Tax Ass~saora
- ~ , 6ooK 197 ~cE y89 ~ -
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