HomeMy WebLinkAbout4797 Deciaration of Domicile and Citizenship
7~U THt: STATI: ANt) ('OUNTY TAX ASSt:SSOR, 2~~~2~
St. I,ucie _ _ ('UUNTY, FLORIUA:
Tl~is is my ~Ir~lar;ition ot~ Damicil~ and Citirei~,hip in thc Stat~ oi Fiorida th~t l am filing this day in
accor~i~nrr, and in roni~ormity with Srction ?'?.17. ~torida Statutr..
i was forn~~rly a Irg~l r~sidrnt ot . K3dc31etOrYl~l_ Neri? YOrk__ ;~nd 1
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rcsidrd at 44 Jt~ekaon Ave. . Howrver, 1 have changed my domicile to
_ _ - - -
(tit~rrt and NumArr)
and am and havr h~rn a bona tide rrsidrnt oi th~ Stat~ ot~ Florida since .-_-__?7th day ot
Dece~ber 7?, and 1 msid~ at Outdoor ??eaorta
' - (Street and Numbrr) ` -
~t. Pierce St. I,ucie
- - - - - - - - • - County. Florida,
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and this st~iemcnt is to he taken as m~~ dcrlar:lllUll OI C1111Ct1S~11~, actual legal residence and domicile in the State
Of F~Of1Cj~t.
(Inxr~ herr any prttinrnt facts, such as salr uf pruprrty or hu~inru, ut relinyu:shment of rmployment ~t former
dumicile, rrmmal uf (amity t~. nr~~ dumicilr. purchacr ot homr. ~•tcJ
Enterin~~ chil~ren in scho~l
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CLERRCCt~.<CU1r C URT
RF.COkC yel'~Flfd
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1~URTHER CERTIFI' that 1~vill register at m~- local address ~vhen the registration books reopen, ~nd
romply with all other rcquiremc nt, r. f,! ir~af resi~ien[ vt~ this $ta[r.
f FURTHER CERTlfY that { h;fvr n~> i~~tention to return to my forn~er domirile, and I intend to remain in
Ft. Pierce St. Lucie ~
. _ _ . - co«~,cy.
i Florida, pcnnan~ntl~~. ~
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oT~ n 2-~'= P,obert ~9. ~Maxwell - - - _ _ _ i
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G : v _ - - - I Addrrss)- - -
v B ti~ : o ~ : F. 0. Box 1116 Jer.sen ?~c, r'la.
'~vqrn to ;u~t~~i~'scribcd hrtc~rr mr thi: 3rd ~l:i~~ c~t~
, .
,
~ ~ ~ ~ ~ Janu~ r
; y ~~.U. I _7% .
~t G-~C-C~ ~CC Kt:-G~[-%
_ Nulary Public Statr uf I 1~~nJa at Lar¢r
~ly Commission cx~irrs - J~tnusry 15, 1976
, (To br r~rcu~eJ m dupl~::~tr .u~J ~~ri~~n d f~lyd t~ith l~terl. t'icaui~ Cuur1. and Supbiate Hith T~a Asu~~r)
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