HomeMy WebLinkAbout0501 • !
D~cla~atlon ot aomicll• a~d Citis~nship ;
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TO THE STATE ANO COUNTY TAX ASSESSOR,
51. IU~IE COUNTY, FLORIDA:
Thi: is my detleration of Oomicile ~nd CitiZS~:hip in th~ St~t~ of Florida thst 1•m filinq thi: day in atoord~nt~ •nd
~n conformity with Chapte~ 222. Ssction 222.17, Florids Statut~s.
1 was forme~ly a Ipal resider~t of All.n Park 1d1Ch. _
(City) _ (Stat~)
end 1~~~ded at __~011 Niver St. However 1 have chan~ed my domic,ile
~ (Street and Number)
ro and am a~d have been a bona fide reside~t of the State of florida s~noe ~ 22nd day of
_ December . ,~9~, and t r~ide et 190 Eaton Dr.
(Street and Number)
FORT r1ERCE, SAINT LUCIE COtiNTY, RORIDA
and tF~is statement is to be taken as my declaration of citize~ship, actual leyal residence end domiciis in the Stste of Horlds.
(Insert here any pertine~t facts, such as sale of properry or business, or relinquishment of employment ~
at forme~ domicile, removal of family to new domitile, purchase of home, etc.)
~ (School Children) ~
,Vicki I;ynn - ?th Grade
Brett Charles - 5th Grade ~d~J6
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~uci~ cou~~i?R~i~.
~ ~osEa Po~tius ~ .
~ECOao vEaRfiEO ceuat ~
D~c 30 !I 42 ~M'~1
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~ 1 fURTHER CERTIFY that 1 will oomply with all other ~squirements of.s lesal reside~f of this StaM.
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~ 1 FURTHER CERTIFY that I have no intentio~ tn return to my former domicile, and I intend to remain in fORT
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, Perma~enf~y. Brent Charles Lemhagen _
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(Name)
~ U°?dd~ess)
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~ Sworn to and subscribed before me this 30th day of December , ~q~,
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1 `~.f}~~~
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~ U~T ~ = Nptary Public
~ By D.C. My Commiuion expires
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(To b~ ydu~licaN snd o~i~inal Hl~d whb Cf~lc Cirarif Gw~, and dupliulr with Tax AsMt~x.)
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