HomeMy WebLinkAbout0080 Okia~ation of Domicil~ and Citis~nship
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TO THE STATE AND COUNTY T-A)( ASSESSOR,
Sl. WCIE COUNTY, FIORIDA:
This is my decleration of Oomicile and Citiztnship in ths St~te of Florida that 1 am filinq Ihis day in sooorda~a and
in conformity with Chapter 2Z2. Secfion 222.17, Florida Statutes.
1 was formerly a leyal roiident of ~ii S C:B(aR,CT~ _
(City) (Stah)
17 S.MADISON STItEBT -
and t resided at - - , However 1 hav~ cherp~d my domidlt
(Street and Number)
ro and am and have been a bona fide resident of the State of Florids :ince ~U~Y 1* 1966 ~ ~y ~
Januarq 66 2703 BOOKBR STRBB'T
, 19 , and 1 reside at
(Stroet and Number)
I~ORT PIERCE. SAINT LUCIE COUMY, RORIDA
and this statsment is to be taken as my declaratwn of citize~ship, attuai lega) rssidenas at~d domidle in the State of Horids.
(Insert here any perti~ent fads, such as sale of property or buaineu, or rotinqvishmsnt of employment
at former domicile, removai of family to ~w domicile, purchase of home, etc.)
HOI~STBAD PURPQSBS
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g~LUC1E CVEA~~~
RECOa
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1 FURTHER CHtTiFY that 1 wiil ~omply with ali othe~ requirements of a IeQal residsnt of thi: State.
1 FURTHER CERTIFY that 1 have no intention to retum to my former domicjle, and I intend to remain irr FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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.:.~u4;~;xi: LBIA DARDBN . (N°"'°)
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-~FU;.-~:~oi•- ~ 2703 BOOKER STREET PT. PIERCE F
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, ~•c:~.r -'t~.-~•~~~~. (~Wdress)
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: 24th APRIL 6?
tiS~or~L.~~_~r~scribed before me this day of , 19 .
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t CLERK CNtCUR Notary PuWic .
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gy D.C. - My Commis~ion explres
(To b~ ~x~aM~d in ei~plieMa and o~in~l til~d w11i~ Cl~t~c Qrarh Gw~1, atw! drpWcala wMh Ta~t As~ot.~
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