HomeMy WebLinkAbout0287 - . ~..~.+~...~:.~.o..-
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Y' ~salaration ot Domlclle and Citizenship
TO THE STATE /W~ COUNTII TAX ASSESSOR, ~
~ Sl. WC1E COUNTY. FlOR1011: ' . ~
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~ Thls is my declar~tbn of Oomidle a~d Citi=anship in th~ St~t~ of florida Nut 1 am f(Itn~ this day in ~ooordano~ and
{n aonfomni~y with Chapttr 2~?. SecHo~ 4Z4.17, Florida Statu»t. ~ t
1 was formerly a Ip~l resW~?f of Hogota ~(~%olumbia ~ . 5a Mmeri~a
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_ and ~~tded •r C~rrera 7285 How.v.r ~ haw chuq.d my domWi.
(She~f a~d NumbK)
b~nd am ~nd haw be~? a bo~?a fid~ rosident of the StaM of flc~ida sina ____._3-~~ daY of
~ ' August 64 127 West Prima Yista Bivd_
19 , and I resWe at
(Stre~f ~~d Numbs~)
. I~ORT ME~CE. S~AINT.~UCIE COUNTY, RORqA •
and this st~hn~snt is to be tak~n at my dsdu~tion of citizsnship, actual lpal residenos ~nd domidle In fh~ Shtr of Horida.
pnssrt hers any pertinent fsct:, such as sate of property or bu:ineu, o? rellnqulshment bf ~nplo~?meM
at formsr domkils, removal of family to new domicile, purduse of hortie, Nc.) 13z~s ,
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~?~J~T ~stablishiag residency ~ .
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~v .......GO;`,~.•~' $T. Lf1CiE COUNTY. fL1R~ .
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~~~~~~~~f+~~~~,~~ Alien X a~13 339 873 -
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1~FURTHER CERTIFY that 1 will ao~npfy wtth ail othu nqulnnMnts of ~ I~pal rakl~nt of M~is Stah.
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~ - 1 RIRTHER CERTIfY Mat I have no intention to ~etum to my fotmsr domWl~, aryd 1(nte~d to r~msin in fORT
PtERCE, SAiNT tUC1E ~OUNTY, fIORlDA, permanently. .
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r : z~~~~. .G~~~ y Robert Bwsn • ~
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~ . Sworn b and wbsaib~d b~fo~ m~ tfiis da of 19c~
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? C COURT Notary Publk ~
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,1 . D.C. My C~omn~ission ~xpira
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