HomeMy WebLinkAbout0470 O~cla~ation ot Domic[I~ and Citi:~nshlp ~-~~~5
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl, tUC1E COUWTY, FLORIDA: -
Thts is my declantion of Domicile and Citi~nship in th~ Sta» of Florida that 1 am filin~ this day in aooondar~o~ a~d
in conf~miy with Chapter 222. Ssttiom 222.1~, Fiaida Statut~s. -
I was formerl a 1 1 nsid~nt of
y pa ~ n
(Ciy) e (Stat~)
.
and i rosided ~f . I~bvwvK 1 haw charq~t! my domidl~
(Stroff and Numbsr)
~
ro a~d sm snd have been a bona fids ros'ident of t~e Staro of Florida sinos /°S day of
~
, 19~, and 1 roside at ~~Q ~
(Street snd Number)
I~ORT N~, SAINT tilC~ CONNTY. ltORIDA
and this stateme~t is b be taken as my deda~ation of citizenship, actual lagai r~idenoe and domidte in fh~ State of Horida.
pnsert here any pertinent fac~a, such as sale of property or business, or relirfqulshment of employnant
at former domicils, removal of family to new danicile, purchase of Fw~r~e, etc.)
i ~ ~ f
. fu. o aNO Re~~RO o~
. ST•R~C 1~ COUN'i'Y. ~LA: ~
ORO VERIFi
.~~'3495 -
'69 ,IA~I ~ AM 10: Zt
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i
CLERK CIRCWT C URT'
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1 FURTHER CtRTIFY that i wili aompiy with all other nquinm~nts of a le~al resident of thts State.
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I FURTFiER CERTIFY that 1 have no intention to ~etum to my formar domi~ile, and I intend to remain in FORT t
PIERCE, SAINT tUC1E CQUNIY, FLORIDA, pemnanently. ~
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;_,~rQrn b and wbsaibed before me this ~ day , 19
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. - _ `fO1TRAS
CIRWfTi~C~IlRT Notary Publk - -
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ay ~''`''C`'l~ ~ aC. My co~,iu~«+ e~~
a. e..~.~~.a ~ a~. ~a «~.i ~.a c~.~ c~ c~, ~a a~.~. Y~ ~.....~a
BOOK ~ 15 PAGE 4~
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