HomeMy WebLinkAbout0966 ~
D~claratio~n af t9omicile~ ~nd Citig~nship ~
1 ti ~ _Y.1 .
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIf: COUNTY, FLORIDA: ,
This is my declaration of Domicile and Citizenship in the 5tate oi F=lorida `rial i am riiing inis day in accoro~?~ce aii~
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of Bzant Lake New York
- - - - --~City) _ . (State)
General UeliVery _ However I havechan ed m domiGile
and I resided at - - - - - - - - _ 9 Y
(Street and N~mber}
to and am and have been a bona fide resident of the Siate of Florida since ._.3 day of
j ar~uary u~ JJC; ~arratit{~~~oh CtrPPt
-
_ _ . , 19___ _ . , and I reside at
-
(Street and Number)
FORT PIERCE, SAiNT LUClE COUNTY, ~LORIDA
and this statement is to be taken as my declaration of citizens{~ip, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
4
at former domicile, removal of family to ne~v domicile, purchase of home, etc.) _
t
1
i
~ Establishin, residence FIL t Pt~C ,~C RU~C ~
~Il~i i~ i
IG~c~ 2~0 ~?~~OK ~
• ~ ; ~ ~ . c•.~.,,,,-k~ , ~
-~6 ,R'.~: I 8 I ! : 36 ~
~ ' : ' - -~_r~ti_~ 1 ~ j
. . . ;
_ : . r;c,,; . , ~ ~-~f~ ;
' _ - - . ;.._t~it .
- " . S-i~. LUC;` C ~i+~i:-(•r.
~ • FI.G ~IDa
. -
. - r , ~
i
fl.~~ j
.:i?t13t?~t:~~~ _
' t
I ~ ~
! FURTHER CERTIFY that I will comply with al) other requirements of a legal resident of this State.
~
I FURTHER CERTIFl' that I have na intention to return to my former domi~ile, and I intend ta remain in FORT
PIERCE, SAIN7~~L~1ClE.COUNTY, FIORIDA, permanently_ .
. ' . . : , . } . ~ • ~ ;
- . .
' ~ ~ (Name) ~
" ` _'f f
- ~ - - ~ Victor Andrew ~ Ceglady _ t
; ' (~ddress) ~
i ''f. r `l:\'' ~
~ - ~ :~li:tlst'~ ~
i8 January b6 ~
t~ Swom to and subscribed before me this day of - - , 19 +
i
I
~ ROGER POITRAS -
LERK C UIT COURT Notary Public ~
~ /
gy S~~r-t- Q`~ D.C. My Commission expires _
` (To be executed in duplicate and origina) filed with Clerk Circuit Court, and duplicate with Tsx l4ssessor.)
~ UR -
, 600K
~
, _ ~