HomeMy WebLinkAbout1069 D
i~eelarati~rr ot ~oft~i~ile ~nc! Citia~ns~tip ;
'
` ~ ~.t~~
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FIORIDA:
Tl~is is my declaration of Domicile and Citizenship in the State of Florida that I am filirig fhis day in accordance and
~ - - - . . . . • r ~
in contormity with l.iiapter 222, Section 222. ~ 7, ~lorici~ ~iatutes.
I ~vas formerly a legal resicier~t of _palo Alto Califori~ia
(City) (State)
~
k
i
and I resided ar 200 K i n~;s 1e y Aven ue Howe~e~ I have changed my dom:~ile `
_ _ - - -
(Street and Number) ~
;
to and am and have been a bona fide resident of the State of Florida since 1.5 day of ~
~
_ _____July _ _ _ ~q__65 and I reside at 231 Fernandina Avenue
(Street and Number)
Ft~RT PIERCE, 5AINY LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal r~sidence and domicile in the State of Florida. ~
(Insert here any pertinent facts, such as sale of property or businass, or relinquishment of employment
at former domiciie, rernoval of family to new domicile, p~rchase of home, etc.)
.
FILEQ_a~~~COt~DED
~`~---~IC COT~ 0 0 K ~
~ - , ~
t
Establistiing residence '66 JAN 20 Ph1 ~:~y !
s
(~y' ~
. ~ .'1:.. .~.L~~~`J~
- . - ~ - ROGER u01-~- ;:~~5. CLERK . ~
. ~ ~ ST. LUCIE COUNTY. ~
` . ~ ~ FLORIDA !
~ ~ -
~ _ . i
. . , . ;
_ • ~ ;
~ ~
~ ~
. y
i .
' I FURTNER CERTIFY that 1 will comply with al) other requirements of a legal resident of this State.
~
i ~
I FURTHER CERTIFY that I have no intention to return to my former domiCile, and I intend to remain in FORT ~
II PIERCE, SAINT LUCIE COUNTY, FLORI~A, permanently.
. C~.~.-(~- ' J~? ~ y'
. ~ . , . .
" (Name)
~ , ~
' _
: , ' . ' • ~
- ` ~ ~ ~ ` ~ Paul Augustin Gross
~ . : .
; ,
~ - ~ (Address)
~ . . `
~ J';;'', ~
' S~+vorn to and subscribed before me this 20 day of Januar~ ~ 19 66
ROGER POITRAS
CLERK Cf UIT COURT Notary Public
gy D.C. My Commission expires
(To be executed in duplicate and original filed with Clerk Circuit Court, and dupliwte with Tax Assessor.)
auo~1~~ 4~i4