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Declaratia~ of Domicile and Citize~nship
TU TfIE 5TATE ANU C'OUNTY TAX ASSESSOR.
S t. L u c i e COUNTY, FLORIDA: 2~~~
This is my drelaratiun of Domicile and Citizenship in the State of Florida that 1 am filing this day in
accordance, and in eonformity with Section 222.17, Florida Statutes.
1 was formerlY a legal resident oP S u m m i t ~ N• T• and 1
(c~~r) ~sa~e)
n:sided at _ 3 9 0 M o r r i s A v e n u e Ho~ver, I have changed my domicile to
(Street and Numbet) -
and am and have been a bona fide resident of the State of Florida since day of
_ April 25 , ~q~ and I reside at 567 So, E. Floresta Dr.
(Street and Number)
P o r t S t L u c i e • S t. L u c i e County, Florida,
cc~~r)
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 facls, such as sak of property or business, or relinquishment of employment at totmer
domic~le, remova! of famely to new domicile, purchue of home, etc.)
Rosanne Fortunato
Applying for homestead exemption
F LED ANO RECpR
. i~. lUC1E COUMT~
ROCER POITRA: ~t
CLERK CtRCU1T CQ{~RT ~
IIECORO YQRIFIEp f~
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1 FURTHER CERTlFY that I will register at my local address when the registration books reopen, and
comply wiih all other requirements of a legal resident of this State. -
1 FURTHER CERTIFY that 1 have no intention to return to my former domicile, and I intend to remain in
Port St. Luc~ie St. Lucie
, , County,
Florida, permanently. (c'ty~
_
~
~ ~i7~t~~~ ~s
Emilio Fortuna~'~S"°~
(Addfess)
Sworn to and subscribed before me this ? 8 day of
April A. . i9 72 .
S~ S~JI~
Notsry Public Sbte of ida at LarEe
My Commission expires _ ~ ~ ~G ~ ~ d~- ` ~
(To be ezecuted in dupticate and ori~tinal filed with Cierk Circuit Court, and duplicate with Tax Assesror)
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