HomeMy WebLinkAbout2037 Deciara~ion ot ~omicile and Citize~ship
TO 7HE STATE AND COUNTY 7AX ASSESSOR,
Sl. IUCIE COUNTY, FIORIDA~
th~s ~s my'N~clarat~on of Dom~ule and Citizensh~p in the State of Florida that 1 em filing this day in accordance and
~n conform~ty w~th Chapter 222, Section 2~?.17, Florida Statutes.
,
1 was formeriy a legal ~es~de~t of _~r~-____ Rew York _
(City) (State)
931 Pierce Ave . . However I have cha ed m domicile
and 1 resided at - - - - - n9 Y
(Street and Number)
1o and am and have been a bona fide resident of the State of Florida since __?th day of
~ay i9_7~_; and I ~eside at _ 10? So. lLanor A~e. Beau Rivage
(Sireet and Number)
FORT PIERCE, SAtNT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florids.
(insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
' Establishin~ resi~ence F~LEO ANQ RECCRDEO
; ST. ROCE
~PBtTRAS ~A
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CIEEtR C~~CUIt COURT
i ~ RECORO VERIFIEO
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~ 1 FURTHER CERTIFIf that I will comply with all other requirements of a leyal resident of this State.
t FURTHER CERTIFY that I have no intention to return to my former domitiie, and I intend to remain i~ FORT
.~~3
PIERCE, SAlN3 L11C1E COUNTY, FIORIDA, permanently.
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(Name)
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= ~ . . (Address)
Swom to and subscribed before me this 3~ day of December 19 ?1
.
- ~ ROGER POITRAS
CLERK CIRCUIT COURT Notary Public
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By ~ ~ _ ' - " ~ D.C. My Commission expires
(7o be executed in duplicate and originsl filed witl~ Clerk Grcuit Court, snd duplicate with Tax Assessor.)
- `QOX ~ v / PACE
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