HomeMy WebLinkAbout0679 Declaration ot ~omicile ant! Cittzenship ;~~5.4 ;
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TO THE STATE AN~ COUNTY TAX ASSESSOR, ~ .
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ST. lUC1E COUNTY, FLORIDA: '
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This i: my decisration of Oomicile and Gitizenship in ths St~ts of Florid~ that 1 am filirp this day i~ ~ooordano~ and !
in oonformity with Chapte? 222, Ssction 2~2.17, Florida Statutes. ;
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1 was formerly a leqal resident of ~'~t~~ _ ~~~~Ct~? ~
(City? ' ~sb) i . _
Hl`03db1'1~9 {
3089 ~i~e Avenu~e I
and I rosided at . Howwsr I have changed my domkik •
(Street and Numbe~) ~
24 I .
' to a~d ~m and have ~ a bona fide resident of the Stats of Florida iinoe day of ~
~ Januaty ~ 64 Ronte 2 Bcoc 30lt2~ I.akewood_Park
, 19_, and I reside at
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l~ORT MERCE, SAINT LUCIE COUNTY, RORIDA Z.
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and this statement is to bs taken as my decla~ation of citizenship, actual legal residenos e~d domidle in ths Ststa of Horid~.
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(Insert here any pertinent facts, such a: sale of property or bu:iness, or ~elinquishment of empioyment
st former domicils, romovai of family to new domicile, purchase of home, etc.)
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Establishing residency -~~r r~a~-94 _
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; ~o` . 19b~ Ju aooK 3~: -
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; 1 fURTHER CERTIFY that 1 wi{I regiater at my local address when ths ragistration books reopen, snd aomply with
all other ~equirements of a legal resident of thi: State. •
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~ 1 FURTHER CERTIFY that I have no intention to retum to my former domidle, and i inta~d to remsin in FORT
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' PIERCE, SAINT .U~CIE COUNTY, FLORIDA, permanently.
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(Nsme)
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; Sworn to and :ubsuibsd before me this ~ day of 19 ~
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~ aoa~e rom~?s
~ CtERK RCUIT COtlRT Notsry Publk -
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~ ~I u~~" ` ~.C. My Commission expires ~
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1 • Re y..x.an.a M~pli~.~. ana «i~inai fil~d whh a.~iC cMa+M c,a+.+, .na aupik.~. wi~~T:x A~as~a- - ;
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