HomeMy WebLinkAbout0150 . S
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O~Ciarition O~f DO~tICil~ illd ~:1tli~nsiMp ~
TO THE STATE AND COUNTY TAX ASSESSOR, .
Sl. IUCiE COUNTY, fIORI~A:
This i: my declaration of Oomicile and ~itimnship in ths Staro of Horida that 1 am filirg this d~r in awordance and
in cor~formity with Chapter 22~, Settio~ 222.17, Horida StstuMs. . ~
I was formerl a 1 al resident of ~-1~~~~t ~
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(GtY) l5tatsl
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and I resided et ~ Hcvvever I hav~e d~gsd m~? domicGle
(5treat and Number)
to and am and have been a bo~a fide resident of fhe State of Horida sinoe dif~ ~
, 19~, and 1 mside at ,1~
~ (5treat and Number)
FORT M~CE, SAINT LUCIE COUNTY. RORnA _
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and this statement is to be taken as ~my dedaration of atize~ship, adusl (egal residenoe and domicib in the State of Horicl~.
(Insert here any pertinent fads, such as sale of properiy or business, or relinquis~+ent of employment . .
at former domicile, romoval of family to nevr dwnicile, purchase of iwrr~e, e1c.)
. - FtLEO ANO RGCO~pEd!
S~. LUCIE COUNTY. ~LA.'
~ RECORD V~RlF~~O -
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i CIERK CtRCUlT CO~RTf _
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1 FURTHER ~ERTIFY fhat 1 will aomply with all other rsquirements of a lepsl resident of this State. .
I FURTHER CERTIFY that I have no intention to return to my former domicile, and.1 iMend to remain in FORT
f
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. .
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~~fd,`~1 subsuibed before me this day of . 19~.~
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:`~'s:'~;; ~ ~i~!l~j~G Notary Public
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~ . ' ' • D.C. My Gommission expros .
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~Ta ` irt~,,dupliuN aed ori~inal fit~d ~ wila Clwlc Gr~a~f Cour1, and dYp~ wi1M Taoc As~~r.~
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S0~ P~6E - -
No. 13
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