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Declaration of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
St. Zucie_ ~pUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am fiiling this day in
accordance, and in conformity with Section 222.17, Florida Statutes. •
1 was formerly a legal resident of Nutley l~ew Jer~e~ and 1
(ci~y) tst.ee~
resided at 14 Ye~npnis Aie. . However, I have changed my domicile to
(Street snd Number) ~ !
and am and have been a bona fide resident of the State of Florida since lst day of ~
~
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April 9?? , and 1 reside at T Rt 2 Box 3501- G ;
(Street and Number) ~
Ft. Pieree St: Zucie ~
, County, Florida,
(c~~r)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. ~
(Inseri Am any pertinent facts, such as salc of property or business, or relinquiahme~t ot employment at former
domiale, remova! ot family to new domicile, purchase of home, etc.)
~ Esta~li~hing residence
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with aU other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former dornicile, and I intend to remain in
~t. Pierce St. .Zucie County,
; ~
Floriqda,.permanendy. (c't''~
.
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~ ~ ~ ~ ~ Chnrles Rus uo~o
~ _ ' ~ . (Address)
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Svvorii; te~ ~nd subscribed before me this - 4th d~y of '
A ril A.D. 19 ?2
~1r~i.G (o
Notuy Public Stat t Elorida at Larae
My Commission expires- ~ - ~
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(To be esecuted in duplicate and originai filed with Clerk Circuit Court, and duplicate with Tax Aasessor)
a~~~01 PA~ .?'2 , _
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