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Declaration of Domicile and Citi~~nship
~ ` ' 301 ~
~I~U Tlih STATN ANU ('UUNTY TAX ASSLSSUR,
St. Lucie
_ _ . _ CUUNTY, FLORIUA:
This is my drei:~r~Uon of lk~mirilc and Citizcnship in thc State of Florida that t am filing this day in
arroniancr, :~nd in coni'orniily with Section 2?2.17, Florida Statutcs.
I was PoRnerly a leg:~l residrnt of _ N e w Y o r k _ _ N e w Y o r k and !
620 E. 54th Street, Brob`~~'yn, N. Y.
r~sidcd at _ . However, I have changed my domicile to
IStrcet and Number)
and am and h:~ve bcen a bona fide nsident of the State of Florida since Z 8 t h day of
3Q9 SWLucero Drive
A p r i 1------^-- , 19 _ 7 2 and 1 resicie at
(Street aod Number)
_ Port St Lucie , St. Lucie County,Florida,
(ci~r)
and this statement is to be taken as my declaration of citizenship, actua! legal residence and domicile in the State
of Florida.
(Irtser~ here any pertinrnt Ixts, such u sak ot Qroperty or business, or telinquishmeo[ of employment at tormet
domicile, removal oi family lo new domicile, purchase ot home, ete.)
Will be employed with Port St. Lucie (General Development
Corporation)
0 AMD REC I
s~i.~iuc~c couNnr°~.
ROCER POtTAA~ fU~~
CIERK CiitCU1T COURt ~
RECaR;~ YERIFIED~..~..~.~
~ ~ 8 ~ ~'~Z
^ ~ 2~30~
I FURTHER CERTIFY that I will registcr 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 1 have no intention to retarn to my former domicile, and I intend to remain in
Port St. Lucie St. Lucie
. , County,
Florida, permanently. «''Y~
/ -
.
L O U 1 S R. S' O t O ~Name)
(Address)
Sworn to ar~d subscribed before me this _ l_ day of
~.,,ututtltt ~ - ~
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- - - - - A.D. 19~ .1•'`';: y`.,,~~~... .
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N y Pu c State uf Florids al e ~ - ;
My Commission cx ires_ /G - . ~ ~tG.- . ~ r'•:
P - - ~r~s -
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(To be execulyd in duplica~e aml onRinal filyd wilh Clerk CircuN Y'op1, ~hd duplicate with T~~ Assewor)
eo~ ~Z~01. ~cE`~40y
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