HomeMy WebLinkAbout4792 Declaration of Domicile and Citizenship
24 ~819 '
TO TtiE STAT~ ANll COUIvTY TAX ASSE.SSOR,
_ ~t _ __.I.~l.~is_ COUNTY, FLORIDA:
Ttiis i, my decla~ation of Domicile and Citizrnship in the Statr of Fiorida that 1 am titing this day in
accordance, and in contorn~ity with Section ?~~.17, Florida Stai«tes.
I was formerly a legal rrsident of __HOllywOOd • - - -----1~'lorida and 1
(City) (Statrl
r~sidrd at ___612~ _Funatol'i_ Street . Howevcr, 1 have changed my domicilr to
IStrret a~d N~mbrr)
•~::;3 !zsve ti}•_~~, ~ h~,n~~ n•c,i~ient of the State ot~ Florida since daY of
__~ptember , ~n_ _66 and 1 reside at _ 100~__Martinique A~re _
(Street and Number)
Ft._ Pieree_-, St. I,ucie County, Florida,
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and this statement is to be takrn as my derlaration of cilizenship, actual legal residence and domicile in the State
of Florida.
(Insrri hrre any prrtinrnt facts, such as salr of pruperty or 6usiness. or relinyuishmrnt of employment at formrr
dvmicile, rrmova! of family to ne~s~ dom~cile, purchese of home, etrJ
2~4819
Eatablishin~ residence
FIlEO AND RECORDEO
- . ST.IUClE COUMTY ftA.
ROCER POItRAS
CLERK CIRCUIT COU1tT
RECORD VERtFtEO...~~
_ ~ 3 10 4a AM'73
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t FURTHER CERTIFY that 1 wilt re~ister ~t rny local address wher~ thr rcgistration books reopen, and
~ comply with all other requirements c~f a lrgal resident of this State.
1 PURTHER CFRTIFY thut 1 have no intention to return to my forn~er d~micile. snd 1 intend to remain in
___^'t. _PiErce_----___ St. Lucie County.
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~ ' Josephir e Z. K~apff
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'~i6p#,r~to•~t'id subscribed before me thi> ~r~__ eia}~ of
,
: January _ _ A.D. 19 73 _
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Notan• 1'ubli. State ot FlonJa at Lar}r
;~fy Commission e~~ire, _ _J~nuary 15, Z976
(To br r~rcuted ~n duphcatc :~nd ~~n~ina( f~(rJ ~~ilh ('Icrk ('ircuit ('o~rt. and duplicafr ~cith Tax As_cccsot)
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