HomeMy WebLinkAbout1321 Qeclaration of Domicile and Citizenship
TO THE STAT ND COUNTY TAX ASSFSSOR,
_ 2276~9
_ COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the Statc of Florida that I am filing this day in
accordance, and in conformity with Section 222. i?, Fiorida Statutes.
1 was formerly a legal resident of ~`[,~t,,~.9 ~01.~~ /~AG~ , J and !
~~r) State)
resided at 1~ ~~,~G.~ ~~1/ . However, I have changed my domicile to
(5treet and Numbcr) .
and am and have been a bona fide resident of the State of Florida since day oC
~~vA.~-°~ , t 9.~y and I reside at 4 /~i1/N i1;
(Sueet and Number)
~ i~/'~ ~ , G vc i~ County, Florida, -
(c~er)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Insert here any pertinent facts, such u sale of property or busioess, or ~elinquishment ot empioyment at former
domicJe, remoral of family !o new domicile, purchsse of nome, etc.)
Sold home in N. Y. and purchaseci
home in Ft. Pierce, Ft. Lucie
County, Florida, and this establishes
me as a resident of said County.
ARO R[C
i?.l1iClE OOU~~ S -
~ ROCER POKUA=
REQ REO ~ERlFIED~
~ Me tt 3 ~o PM'~i
2~so9
I FURTHER CERTIFY that I will register ai my local address when the registration books reopen, and
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 domicile, and I intend to remain in
_ ( ~e_°,~Gr~°i , SJ!' GvG/PJ , Caunty,
Florida, permanently. cc~rr~ .
George jol~rn Heinlein `
~ .
c~•
~~.~,.Q, •
, ddre~
Sworn to anc~,s~,~~for~:me this 1 ~ day of
~I^.~
Ap~,~~,.-._ 72
,~s ~.4~ A.D. 19 .
: ; -s r
~i ~ ~ ~PpQNc Stat~ ~F'lorida at e .
. : • . .
, . ~ y 0 R
I ~ ~ ~a1 ,"t~~, y r~S.'' ~
My ~omm,~:;~ , ~ ~ _ ~~Qi ~~~19
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,
~ "(To be.executed in duplicste and original Cdrd with Clerk C'vcuii Couri, and duplicate with Tan Assessot)
,r~ A(~~(; 1
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