HomeMy WebLinkAbout0777 2( )28.~2
O~cla~ation ot Domicil~ a~d Citis~nship ~
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10 THE STAYE AN~ COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FLORI~A
This is my declaration of ~om~cile and Citizenship in ths Stete of Florida that 1•m filinq this day in acc~ord~nte and
~n confo.mity with Chapter 222, Section 222.17. Flo~ida Statutes. !
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1 was formerly a legel rasident of _~'_'_R~ ~L4~__ _ a-'''v
(City) at~)
and 1 ~asided at ~L~'L~~ • - - However I have chanqed my domitile .
(St eet and Numbe~)
to and am a~d have been a bona fide resident of the State of florida since ~ dsy of
~.c. - 70 ~ S~/ ~ ~
19_-, and I reside at
(Street and Number)
FORT tiERCE, SAINT LUClE COUNTY, RORIOA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Inse~t here any pertinent facfs, such as sale of property or busineu, or relinquishment of employment
at former domicite, removal of family to new domicile, purchase of home, etc:)
~-t~r u- - by ~ ~~C
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2G28~2
~~LEO,?MO sfooROe~
ST.lUC1E COUMtY fL
IIOCfR POlTI1AS ~
11ECORD VERRf1E0 COU
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' I RJRTHER ~HtTIFY that 1 will aomply with all other requirementt of a leyal resident of this State.
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~ 1 FURTHER CERTIFY that I have no intention to return to my former domic.ile, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ (Nsme)
~ t!``:u~~~~?',,, CARLO ROY~ANO
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~uhsc~ibed before me this day of , 191L.. ~
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g GRCUIT COURT Notary Public ~
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; y D.C_ My f.ommiuion expires
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~ Ro b~ ~x~cv~~d in ddplic~ and ori~i~al fil~d witb Cl~rlc prwil Court, and duplicaN wilh Tax Asw~o~.I
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so~K 1~9 Fn~F ?75
No 13
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