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Declaration of Domicile and Citizenship
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1~0 TtiE STAT ~ AND COUNTY TAX ASSESSOR,
_ GOUNTY, FLORIDA:
77~is is my declaration ot' Domicile and Citizenship in the State of Florida that l am filing this day in ?
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accor~ance, :~nd in conformity with Section 222.17, Florida Statutes. i
1 was formerly a lega! resident of - Roehester , N. Y. and I ~
(c~~r) (s~.~e~ ~
rrsidcd at _ 240 LeChase Drive - Apt. C However, 1 have changed my domicile to ,
(Street and Numbe~) ~
:,nd ~m and have been a bona fide resident of the State of Ftorida since 22nd day of '
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May , l9 and 1 reside at 164 South Naranja Avenue ~
. (Street and Number)
__Port t. LLG;~,~`t Pierce, St_ T.~~ie Gounty, Florida,
(Citr)
:~id this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
ot Florida. ~
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(Inseri here any {?ertinent facts, such as sale ot property or business, cx relinquisAment of employment at tormer ~
domicile, removal of family to new domicJe, purc6ue of Aome, eic.)
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Building a home in St. Lucie County
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CIERK Ci~CN{T COtMT ~ ~ !
RECbRO YERIf1Eb r
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1 FURTNER CERTIFY that I will register at my la;al address when the registration books reopen, and
comply with all other requirements of a legal resident of this State. ~
1 FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
Port St. Lucie, Fort Pierce, St. Lucie County,
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Hlorida. permanently.
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~ SC~ (Name)
~ john . ~ .
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Rose M. Crisci ~
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S~~~orn to and subscribed before me this 21 - of ~
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july 72 - ~
A. 19 ' ~
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= l : .l~i~_ • ~ • ~ ~
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~ - otary PuMic State of rida at LarEr ~ - ' `~y3 `
~1y Commission expires-~-1G ' 7 3 _ ~ . F~
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(To be esecuted in duplicate and origin~l filed with Clerk CitcuR COUrt, snd~tluplicate wilh Tax Assessor)
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