HomeMy WebLinkAbout1084 Declaration ot Domicile and Citizenship
. 221199
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FIORiDA: ;
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This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accord.~nce and ~
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~n conformity with Chapter 222, Section 222.17, Florida Statutes. ~
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I was formerly a legal ~e:;de~t of New _ York Cit;~_ I,on~__Ialand It'ew York ~
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(Ciry) (State) ~
4 ~iller ~?lvd S osaet ~
and 1 res~ded at . 4_ ___i _1~_._______ . However 1 have changed my domic.~le
(Street and Number) ~
ro and am and have been a bona fide resident of the State of Florida since _ 17th _ day of `
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_ ~a1+ _ _ _ ~4'71 , and I reside ar _110 L__Aldea Stree+~ River Park ;
(Street and Number) ~
FORT PIERCE, SAINT LUCIE COUNTY, FLORiDA
and this statement is to be taken as my declaration of citizenship, actual l~gal residence and domicile in the State of Florida.
(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.)
22~99 .
Eatablishing resicence
:T~lUC1E cniE~
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' CIERK C:t;y~IT C URT
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I FURTHER CERTIFY that I will comply with all other requirements of a leyal resident of ihii State.
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1 FURTHER CERTIFY that I have no intention to retum to my former domi~ile, and I intend to remain in FORT
~ PIERCE, SAlNT LUCIE COUNTY, FLORIDA, permanently.
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~ (9aicDmss) Ed i th
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;y Swom to and subscribed before me this ~9th day of Deeember ~ 19 71 ~
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ROGER POITRAS ~
LERK CIRCUIT COURT Notary Public '
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By _ D.C. My Commission expires ~
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(To b~ executed in dupliute and oriqinal ~iled with Cl~rk Grcuit Cou~f, and dupliut~ with Tax Ass~stor.) ~
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