HomeMy WebLinkAbout0736 A
D~~Oar~tior~ o~ Dt~micile and Citizenshi~a -i~i~s3
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TO THE STATE AND COUN;Y TAX ASSESSOR,
;
S~. LUCIE COUNTY, FLORIDA: ~
Ttiis is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordante and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
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I was formerly a legal resident of _ P4r t__ S31~x1]Q _______1S. ~
(City) (State)
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and I resided at - - _ _ _ - _ - - - - However I have changed my domi~ile
~ ~Street and Number) ~
to and am and have been a bona fide resident of the State of Florida since 6th__.___ day of
llecember ~q_ __b,5and I reside ar 114_North 18th street
- _ - -
tSt:~ei o~d Numb~r)
FORT PIERCE, SAINT WCIE COUNTY, FLORIDA
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and this statement is to be iaicen as my aeciaraiion oi ciiizensiiip, aciuai ieyai ICS~Ut'III.C tlIW UVtt11L11G ~~~~:,~a~~:.~ ~:~~;~c. ,
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- (Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment ;
i
at former domicile, removal of family to new domicile, purchase of home, etc.) ~
~ Applying for homestead
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; F1LED AND REC RDED ~
. O~K. ~
{ . ; ~ Q{~iE~B~-~~~01
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' _ : . . '66 J~~~ 13 A~1 I l Y ~2
~ .ti. . ~41_.~~~
t ~ ~ " ~ ~ n~c
f= _ ' ftOG~_!t 1='~;z ; , ~L~
i. . . ~ - ~ - - si. ~UCiE'COUNTY.
. ~T~ - FLORIDA
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1}t ~ • ' • - ~ ~ ~ - '•~,`I ; -
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x '•~^,t''~~ •~1,'11``,,.
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I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
. • ~
I FJRTHER CERTIFY that I have no intention to return to my former domiCile, and ( intend to remain in FORT ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_ ~
...,;;~;;~c~c:r:, ~ ~
; ~Uj-; ~
F ; ` . D • (Name)
~ ~:~1'; - r.~ ~'i,
'cG•, Robert Greenberg
' ' ~ 4~~ I
~ _ *:l : f i~ii.~.::,"~ `Y - . ~
~ U• _:.s ~~a_•t„f! jf.. ~ e (~1C~df@SS~
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~ ~ • ~~,4_~~~ .1 : ~
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' _ ^ '~~j ~ . ` `N
- ~~~~(,C+ ~ini~'r~+ Iq~~nd subscribed before me this 13th day of --~Tanaury ~ ~q ,
~ 'j%l~:~o~ti~~~`
ROGER POITRAS
RK CIRCUIT COURT . Notary Public
gy ~ D.C. My Commission expires "
j (To ba executad in duplicate and original filed with Clerk Circuit Court, and dupliute with Tax Assessor.)
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~ BOOK 136 ~.3~. -