HomeMy WebLinkAbout2960 Declaration ot Domicite and Citizenship
TO THE STATE AND COt1NTY TAX ASSESSOR, 2224'73
Si . LUCIE COUNTY, FIORIDA.
Th~s ~s my declarat~on of Dom~cdle and Cit~zensh~p in the State of Florida that I am fil~ng this day in accordance and
,n conformity w~th Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal res~dent of EATC!NTOr1111 _ N. eT _
(City) (State)
and 1 resided at 1 94 C1~YLtQA AV~. _ _ _ However 1 have changed my domi~ile
(Street and Number)
ro and am and have been a bona fide resident of the State of Florida since . 3rd day of
Auguet .~v 71 , and I ~eside at _ ~50 So._ ~ntrad~ Ave.. P~~~~. Lucie
(Street and Number)
~ORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and ~omicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employ~nent
at former domicile, removal of family to new domicile, purchase of home, etc.)
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RESIDENCE
- FILED dyr, ..E~uR0E0
ST.lUC1E ~GUhTY FlA. `
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' I FURTHER CERTIFY ihat I will comply with all other requirements of a legal resident of this State.
~ I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, pumanently. ~
a° ~
- SAb~UEL GAROFALO
~ ~ - ; (Name)
_ ' : ' .
= _ . : 150 So. Entrada Ave__. Pt. ~t_.~__I,ucie,_ _
' - - ~ ~ (Address) ' 33450
. ~ -
i:y ,~worR,tti ~d3ubscribed before me this 21 st _ day of !januel~- . _ _ , 19~--
_ . . 4 - - -
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ROGsR POITRAS -
C K RCUIT COURT ~ Notary Pubiic
_ / ~
By ' _ . , _ ~ _ _ _ D.C My Cqmmi$gipn Px~irQS
" (To be executed in duplicate and original filed with Clerk Circuit Court, and duplicate with Tax Assessor.)
: .:a , 3 gQOK 198 P~~E2957
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