HomeMy WebLinkAbout0712 D~cl~ration ot Domictt• a~d Cit~~nshlp
TO THE STATE AND COUNTY TAX ASSESSOR, ~~~~5
Sl. UJCIE COUNTY, FlORIOA: '
This is mr decla~~tion of Domidle and Citize~ship in th~ State of Horid~ that 1 am filin~ this day in aooo~dana and
in aonformity with Chapter 22Z, S~ction 222.17, Horids Statutes.
1 wa: formsrly a leyal r~idsnt of A~g~a CaliYorni~?
(~fY) (Sta»)
and 1 rosld~d at 25906 Calaroga A~s. i~„~ ~,y ~,w~e
~t and Number)
ro a~d am and have been a bona fide msident of the State of fiorida sinoe 15~ dsy of
Angnet ,~q 68 , a~ i~,~ ~ 765 Lindo Zane Ri~er Park
' (5treet and Numbsr)
FORT MBC~, SAWT LtIC1E COtMITY, RORIDA
and this :tatemsnt is b be taken as my daclaration of atizenship, actual legal residenos and domidle in the State of Florida.
pnsert here any. pertinent facts, such aa ssle of property or business, or relinquishment of employment
at former domicile, removal of family tQ new domicile, purchase of home, etc.)
Eetablishing reeidence
~~~E~ AN~ R~CQROED
ST. LUCIE COUNTY. ~~,q.
RECORQ YFRIFIEO
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e: s1
.
~
' ` ROGER POITRA$
CLERK CIACUIT COURT:
1 FURTI~R ~HtTIFY fhat i will aomply with ail other r~quirenwnts of ~ lep~l ~ident of fhis State.
1 fURTHER CERTIFY that I have no intention to retum b my former domicjle, and I intend to remain in FORT
PIERCE, SAINT IUCIE COUNTY, FLORIDA, permanently.
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~ , }'o s~ 8naeel ~ame) aayaon Heye
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~~~~,,<.U~'~ ~G~.~~` ~ Hermiome gether~ne Heye
Sw«i+~i~":nd wbscrib.d be~or. m. t1,i: lst d,y ~ Fovember ~q68 ,
ROOiR rO1TRAi
C~CWT tOURt Notuy Publk
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