HomeMy WebLinkAbout2217 Deci~~ati~r+ ot ~omi~ile And Citiz~en~hip l~~~~~<< f~
TO THE- STATE AND COUNTY TAX ASSESSOR,
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Sl. IUCIE COUNTY, FI.ORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes. ~
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I was formerly a legal resident of U 15 V i l l e_` K~~ Ll~kj~-__-___. ;
(City) (State) `
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925 Ellison Avenue ~
and I resided at - . However I have changed my domi6ile
(Street and Number)
to and am and have been a bona fide resident of the State of Fl~rida since _ 8___-_ _ day of ~
June 65 835 Airoso Blvd ~
- - - - - - , 19--- , and I reside at - - '
(Street and Number)
FORT PIERCE, SAiNT LUCIE C~UNTY, FLORIDA
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df1O Il11S Sldletllefli 13 IV UC ialiCii a~ ~iiy ucCiaiciivi~ ui Ciii~ci~5iiif,, u~iL'u'i ia:yui II.JIV4~iC.V a~:.,......-...,... ..::::c:,._...
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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FILED AND '
Establishing resi~ence t",~ n EC ~p~D =
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sr. ~uc~E covr~ ~ rRK ~
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; I FURTHER CERTIFY that I v~ill comply with all other requirements of a legal resident,- O~~tt~s`-~.State~; ~
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E I FURTHER CERTIFY that I have no intention to return to my former domic~le, and I intenc~'_`fb'_~t~~ig in FORT ~
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; PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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f . . (Name) 1
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ij - . George A. Rossfeld ~
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$~vsotrir torand~subscribed before me this - lb day of _ Februar~ , 19_~6. ~
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ROGER POITRAS - }
CLERK CIRCU T COURT Notary Public ~
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gy _ D.C. My Commission expires {
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(To be execute~l in duplicate and origina) fited with Clerk Ci~cuit Court, and duplicate with Tax Assessar.) ~
° R ~.38 ~11 '
BOOK . ~