HomeMy WebLinkAbout2113 _ . . .
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Deci~r~tio~ at Domicile and C1tlzenship
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Tp THE STATE AN~ COUNTY TAX ASSESSOR,
ST, IUCIE GOUNTY, FIORI~A: " ' ~
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' This is my declaraNon of'Oomicils and Gttizenship in ths State of Florida that i am ftiinq thit day in eooo~denos and
!n oo»formlty with Chapter 224. Seetion 222.17, Flarida Statutes. ' ~
Reidsville North Carolina ~
1 wa~ formerly e leqal rosidsr?t af _
K~tY) (State) '
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end !~sided at _ Routa 'T ~~c - However 1 have chan~ed my domiCile
(Straet and Numbe~) ,
~ to and arr and have baen a bona fida resident of the State of Floride since ' 28 day of
J~tna 6~ 603 . Az~lea Avenue
19 , and 1 raside et
. ' ~ (Stroet ar~d Numberj
fORT MERCE, SAiNT tUCtE COUNTY, RORIDA . ~
and this~statement i: b be taken a: my declaratio~ of dtizenshtp, actual lsgal r~idenas amd domicile in the State of Florid~.
pnsert hero any pertinent facts, such as sale of property or business, or relinquishms~t of employment
at forme~ domkils, ren~oval of family to new domicile, purchase of twme, etc.)
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Establishing residenae _
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t ~ RO~ER FOITRAS CtERK
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I FURTHER CERTIFY that I will ~np~Y ~ ~
att other r~qvirements of a fegel resident of this Stab. ~
i RlRTHER CERTIFY that i have no intention to retum to my forme~ domic~le, and f imend to mmaln in FOttT
PtERCE, SAINT LUCtE COUNTY, FCORIDA, pemnanently. . ~ , ~
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- Swor~ to and wbscribsd before me this 18 d~,y AVp~t18t 19 ~
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Ct R COUitT , Notary Pubik
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BY . . D.C. My Gommiuion expiras
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I ~ tTe b. ~ueut.a M av~,~lea~. .na oriqinat fitea witi~ a.~lc ararit eourt, .ea dupua~: wNh T.x At~t~ora
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