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Declaration of Domicile and Citizenship
r~ ~rtir. s-rn~r~: nnu cOUNTY TAX ASSI-:SSOR, 228302 :
St. Lucie
_ _ _ COUNTY, FL.ORlllA:
71~i. is my drelaration ot' Uomicilc and Citizcnship in thc Statc of Florida th:~t i am t~i~ng this day in
~ccor~lan~r, and in conformity with Section 222.17, Florida Statutcs.
1 was formcrly a legal rrsident of _N e w Y o r k ,~N e w Y o r k and 1
25-39 44th Street A~tol~i'~ , N. Y. cs~,«~ .
r~sidrd at However, 1 have changed my domicile to
(Street and Numbet)
~nd am and have b~.~;n a bona fide nsident of the State of Florida since Z 8 _ day of
Apri 1 ~ 2
, 19__, and 1 reside at 3 0 9 S W L u c e ro D r i v e
P o r t S t L u c i e S t. L u e i e ~Street aad Numbe?)
- . ~ County, Florida,
tc~tr) .
and this statement is to be taken as my deciaration of citizenship, actual legal residence and domicile in the ~;s:s
uf Florida.
(Inser~ here any pettinent txls, such u sale of ptoperly or business, or relinquishment of employment at totmer
domicile, removal ot family to new domicile, purcAast of home, etc.)
' Working with General Development Corporation
fILEO AMO NECQR ~
. ST. L11CIE COUNTY ~
R06f R ?OITRAS .
C~ERK CiRCUtt COU!!? ~
~ l1ECOR0 VERlFIEO`~
Miur I 8 3i AN'1Z
~302
1 FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with all other reyuirements of a legal resident of this State. ~
' 1 FURTHER CERTIFY that 1 have no intention to return to my former dbmicile, and I intend to remain in
Port St Lucie • St . Lucie
, County,
Florida, permancntly. (c't''~ _ .
~ ~l!-t-t> _-C~-r~ .
• (Name)
Henry Herrera
- - aar~)
' .:r._--
Sworn to and subscribed before me this 1_ day of `~,~~~i
N,~a~~~r~i~y!'- ~
M a y 7 2 ,••~p,.~« ...,~.t~ .,~r~; .
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Notary PuMic State of rida st large ; ~ o.~
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(To be r~eculyd m duplicale and ori~tinal filed with Cletk l'ircuN Court, and duplicsle wilh Tsx A[saaw)
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bO~K ~V PACE
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