HomeMy WebLinkAbout0756 ~cla~atlon ot Doml~il• and Citis~nshlp
TO THE STATE AN~ COUNTY TAX ASSESSOR,
51. WCIE ~OUNTY, FIORIDA:
This is my dcclaration of Domicile and ~itisenship in the State af Flo?id~ that 1 am filiny this dsy in saord~nce and ~
~n confo~mity with Chapter 2~2, Section 422.17, Flo~ida Statutes. t
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I was formerly s legal res+dent of ~1b8 _ _ A18b8t08 _
(Ciy) (Stats)
and 1 resided et Rt_._. _~_BO]C 19~ However 1 have cha~yed my domic3le
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since 25th day of
-_--De~e~1~~----- , t91~ , and 1 ~eside at ~ P. 0. Box 1203
~ (Sheet and Number)
FORT PIERCE, SAINT LUCIE COUNTY, ROR{DA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(I~sert here any pertinent facts, such as sale of property or business, or relinquishment of employment `
at former domicile, removal of family to new domicile, purthase af home, etc.)
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(School Children)
Cynthia Suree - 6th Grade 2C~~~
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E CQtI~'tA.
Zucretia Lynne - 4th Grade ~~6ER ?OITR~~ ~ ~
CLERII CIRCWT pp~11t Q•
IIECORD YERIFIEO.~,~.~:
Cydra Dawn - lst Grade
Ju~ ~ 9 ~ AM'II
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~ I FURTHER CERTIFY that 1 will comply with all other requirements of a le~al resident of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domitile, and ( intend to remain in FORT
€ PiERCE, SAINT LUClE COUNTY, FLORIDA, permanently. CeCll E. JOhIISOri
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~ (Name)
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~ Sworn to and wbscrib~d bpfore me this 4th day of January ~q~,j_.
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~ BY D.C. My Commission expires
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~ Ro b~ and ai~inai fil~d wilb CIKIc Ci~wi1 Cou~, aed duplicat~ wiN~ Tax Aswaor.)
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