HomeMy WebLinkAbout0182 _ ~..:.v.::i'' . •a. _ . _ _ . ~ ~
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: Oeciaration ot Domiclle a~d Citlsenship
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~ TO THE STATE MID COUNTY TAX ASSESSOR.
Sl. LUCIE COUNTY.~ FIORIDA:
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~ This is my datlsration of Oomicile and Gitiunihip in the Stats qf F~aida that 1~m filin~ fhis day in aooordano~ end ;
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~ in conformiy with Chapter Z22, Saction 22~.17, Florida Statutes.
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I was for~ y a legal resider+t of -
(Cir (State)
~nd 1 rosided s 104~ HAdl~.lt . Howevef 1 hav~ chan~sd my domidle ;
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to ~nd ~m a~.,. . ~e be,en a bona fide resident of the State of f,~~,~a since ~~h day of =
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S ~7 , 19~ . •nd I roaide at ~ Rt• ~ ~ ~780 -
(Street and Number) '
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FpRT ~IERCE, SAINT ~tK1E tOUNTY, FI.ORIDA
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• 1 and this statement is to b~ taken as my declaratton of citizenship, actusl leyal residenos and domidl~ in the Stste of Horida.
~ pnseN hers any pertinent facts, such as sale of propery or business,.or relinquishm~+t of employmer~t
et former domtdle, removal of family ro new domicil~, purchase of home, etc.)
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~~'L•' ST. LllCiE COU;ITY, FIOR
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i 1 FURTHER CERTIFlf thst 1 will rogisror at my loal address when the reyishation books reopen, and oomply with -
~ aii other requirements of a le~al rosident of this State. _
~ 1 FURTHER CERTIFY that 1 have nu intention to return to my former domiple, and 1 intend to mmain in FORT
~ ~ PIERCE, SAINT LUCIE COUNTY; FLORIDA, permsnently.
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j U••.... ks and wbsaibsd before me this _ day of TaIIL1dZ? , 19~_.
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i rpiTRA:
i IT Notary Publk
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i b~? .C. My Commission expi~es
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~ R~ b~ ~x~arhd M and ~i~iwal Al~d whh G~ek Ci~a~it Couh, and dwpltab ~ a Qe~
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