HomeMy WebLinkAbout2700 D~claration ot Domicil• a~d Citlz~nship
TO THE STATE AND COUNTY TAX ASSESSOR. ~0~~~~
51. LUCIE COUNTY, fIORI~A:
This is my declaratio~ of Domicile and Citizanship in ths State of Flo~ide that I am fili~g thi: day in aaotdante and
in conformity with Chapter 222, Section 222.17, Fiorida Statutes.
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1 was formerly a legel resident of _ _
(Ciy~ (Staro)
and 1 ~esided et~ However 1 have changed my domitile
(Sireet a~d Number) ~ ~
b and am and have been a bona fide resident of the Stste of Flo~ida since day of
- -"'!L~(/~/ , 19 Q, and I roside at . ~ ~
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(Street and Number)
FORT M~CE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaratio~ of citizenship, actual legal residence and domitile in the State of Horida.
(Insert here a~y pertinent facts, such as sale of property or busi~ess, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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~UCiE CQUMTYRF~
RQCER POtMA= -
CLElllt C1RCWT COt1AT
RECORD YERIFIEO
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~ O~c i5 il 29 AM'T8
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2~2152
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~ 1 RJRTHER CERTIFY that 1 will aomply with all other requirement: of a la~a) resident of this State.
~ I fURTHER CERTIFY that I have no intentian to retum to my former domicjle, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FIORIDA, permane~tly. .
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'~-'~~i~ ~~S~iA~t~~`'and subxribed before me this ~s~ day of . 19~5?.
a ~J:~~~r~IH~titi :
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ROOE~ ~OITRAs
q~ERK CONRT Notary Public
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By O.C. My Commission expires
(T~ b~ ~onc~Nd ia dvplicaN ~nd e~i0inal fil~d wilb C{~elc Ckt~if Courf, ~nd duplicat~ witb Tax A~~.~
eooK188 P~~6g5 ,
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