HomeMy WebLinkAbout1479 ~
I~ecfaration Qt ~Qr~i+~~l~ ~~~~4P~±~~~;~ ~~i~° ~
TO 7HE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FLORIDA:
This is my declaraiion of Domicile and Citizenship in the State of Florida that 1 am filing this day in actordance and
in conformity ~vitli Chapter 222, Sect;on 222.17, Florida Statutes.
I was formerly a legal resident of . Y~nkers__ _ _ _ New YOrk _
(City) (State)
and I resided at _ z61 Palisade A.~~. _ . Ho~vever I have changed my domiGile ;
(Street and Number) ~
to and am and have been a bona fide resident of the State of Florida since 217d _ day of
September 65 2010 Rpo Vista Drive
- t9----., and 1 reside at
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and fhis statement is to be taken as my declaration of citizenshi~, actual Iegal residence and domicite in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicil~, remova! of far.~ily to new domicile, purchase of home, etc.)
hew Domicile ~
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R~~DED
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BOOK ~
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~ •`t;-'y' : , ROG~i-: r=~ , GLERK
~ ST. LUCIE COUNTY
' ` i ~ G FLORIDA ~
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~ I FURTHER CERTIFY that I will ~omply with all other requirements of a legal resident of;t~iis~Sia - ~
F , _ : "„1 , ,i~:: . = `
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I FURTHER CERTlFY that I have no intention to return to my former domi~ile, and I~irit,~tic~: ?o',t~main•~~n~ ~~R7
, F
.
PIERCE, SAINT LUGE COUNTY, FLORIDA, permanently. ' : ' ; ~ ~
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t _Th mas Lo~hroU Frederick ~
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' ? (Name)
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(Address)
Sworn to and subscribed before me this _ 31St day of _ January ~~9 66
~ ;
R4GER POITFtAS ~
CLERK CIRCUIT COURT Notary Public '
~
gY U_i~,,~~„/j~- ~1~~4~(1`` D.C. My Commission expires
(To be executed in duplicate and orgina) filed with Cl~rk Circuit Court, and duplicate with Tax Assessor.)
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