HomeMy WebLinkAbout2170 2G1802
Oeclaratlon ot ~omicil• and Citl:~nship
TO THE STATE AND COUNTY TAX ASSESSOR, '
Sl. lIJCiE COUNTY, FLORI~A: '
This is my decla~ation of Oomicile and Citizenihip in tht State of Norida that 1 am filinq this day in aaorda~u and
in oonformity with Chapter 222, Section 222.17. Horide Ststutes.
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I wes forme~ly a leys) ~esident of ' -
(City) (Stah)
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and I ~esidad at ~ U ~ . However 1 have tharpsd my domkile
(Street and Number)
ro and am a~d have been a bona fide resident of the Staro of Flvrida sinoe !1 ~ day of
19 and I reside at ~~C 6~ s• ~~~C.'X • ~.~~!-Cl L_S~`Ki~-
- • --~,~.•l
~ . (Street and Numbx)
~ORT M~CE, SAINT UlCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizeruhip, actual le~al residence and domkils in the State of Horid~.
(Insert here any pertinent facts, such as ~le of property or business, or rolinqui~ment of employmemt
et fomner domicile, removat of family. to new domicile, purchase of home, etc.)
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1 RJRTHER CEitTIFY that ! will oomply with all othsr ~equirem~nUs of a lepal resident of this State.
1 FURTHER CERTIFY that I have no intention to retum to my former domic,ile, and 1 intend to remain in FORT
PIERCE, SAINT lUC1E COUNTY, FLORIDA, permanently. -
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. tNeme) ~e o~,(J; l 1 i 41+~ S
(Addres:)
Swprn ~'~~wb~tribed before me thi: day of 19 •
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BX ` ` D.C. My Gommii:ion expir~s
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.~ii~'+o~.M!~~i~ d~Nsa~ .wr .ei~n.~ fll.a ,aMl~ a«k ci~cvM cew+, .ea d~lk.» a?hb Tax A~......a
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„ ~ ~oox1$8 ~2167
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