HomeMy WebLinkAbout0456 .~.....:..r.-,.. , . .
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Dealar~tion o~ Domicite ~nci ~i~isansP~t~
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TO THE STATE AND COl1NTY TAX ASS~SSOR, ~ '
ST. LUCI@ COUNTY, FLORIDA:
This is my declaraHon of Oomicile and Citizansh(p i~ ihe State of Florlda that I am filfn~ this day in actotdante and
. in Gonformity with Chapter 222, Saction 222.17, Florida Statutes.
~ALTI MORS I"~ •
I was fo~marly a legal resident of -
(City) (Stste)
and 1 rosidcd at 161? NOrthwiCk Rd. Howevsr I have chanyed my damiclla
~ (Street and Number)
to and am and have bcan a bona fide rasident of the Statn of Florida since ~ St$ ~ day o~ A~
A'ugust ' ~ ~q64 ,~nd I reside at ~4~ 81 Sito Crt. ~
(5treet and Number) ~
~ ~ORT ~IE9tCE, SAINT LUCIE COUNTY, FLORIDA . • •
and this statement is to be taken as my declaration of ciHzenship, actual leqal rasiden~ce and domicile in th~ Stab of Horida.
4~~ • "
t.~ ~ (Insert hero any pert+nent facts, such as sala of property or businesa, or roiinquishme~t of employment ~
x
? at former d'nmicile, removal of family to new domicile, purchasa of home, etc.)
PILING FOR HOM&ST,B~D PURPOSBS .
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~~i~~f~~'~" 4 NO`~ 20 AM 9~ ~+3 ~ . ~ ~ ,
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, : .~s--~ ~ -:.r . ROGE ~IaRID _ _ _
:~`-~u~~~ t,_`.:.•~; t ST ~UCIE COUN1'~? ~ : .
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i FURTi~fER CfR?IFY that 1 will oomply with all other requ(rerr?~nts of a te~a! reildent of fhls St~te.
1 FURTHER CERTIFY that ( hava no intention to retum to my former domfs~le, and I intend to remain in FORT ,
~ PIEttCf, ~AiNT LUCiE COUNTY, FLORIDA, permanently. ,-t '
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(Nama) .
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~ - CHARLBS 5. K1$?UFMANN ~
(Address)
' 2ath Novembes . . . ~
.~n to and ivbycrib~d befon nea this day ot ` 1.~;*.!_.
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