HomeMy WebLinkAbout2567 Declaration of Domicile and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR, ~~F.~SO !
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Sl. WCIE COUNTY, FIORiDA: '
This ~s my declaration of Dom~cile and Citizenship in the State of Florida that 1 am filing this day in acco~dance a~d
~n conformiry with Chapter ?22, Section ?2?.17, Florida Statutes.
I was formerly a legal resident of TOledO __Oh10_
(City) (State)
and 1 resided at 2641 1 19th Stre@t However I have changed my domicile
(St~eet and Number)
ro and am and have been a bona fide resident of the State of Florida since ~?th day ot
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_Jull ,~9 71_, and 1 reside at 149 _LB~ehurst Dri~e, Port St. Zucie ~
(Street and Number)
FORT PlERCE, SAlNT LUCtE COUNTY, FtORlDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(lnsert here any pertinent facts, such as sale of properry or business, or relinquishment of employment ?
at former domicile, removal of family to new domicile, purchase of home, etc.)
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RESIDFA~CE FILE~ ANO nECORDEO
ST. LUCIE COUNTY fLA.
RO"vER ~OITRAS
- CLE~K Ci<<CUtT COURT
RECOKi~ v= ~rtt:
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~ I FURTHER CHtTIFY that I wiil mmply with all other requirements of a legal resident of this State.
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~ I FURTHER CERTIFY that 1 have no intention to return to my former domi~ile, and I intend to remain in FORT }
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~ PIERCE, SAINT IUGE COUNTY, FLORIOA, permanently. ~ ~ ;
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~ ROBERT COIISINO ;
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~5 . (Name) ~
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f~' • - ~ ~ - ~ ~ '149 Lakehurst DriTe, ~'t. Pierce, ~'1.
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~ • (Address) 33450
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Swom.to~KC~subscribed before me this - ~ 7t~ _ day of J8AU.8T~ ~ ~q 72
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~aGER POITRAS
K CIRCUIT COURT Notary Public
:r~ By D.C. My Commission expires
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(To be executed in duplicats and oripinsl filed with G~ric Grcuit Court, snd duplicat~ with Tax Ass~ssor.)
s~~x 1g8 PAC~ 2564
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