HomeMy WebLinkAbout0894 D~cla~atio~ ot Oor~lail~ a~d Cit~~nship
TO THE STATE AND COUNTY TAX ASSESSOR, .~,Q~(
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Sl. lUC1E tOUNTY, FLORIDA:
This is my decla~ation of Domicile and Citis~r?ihip in ths St~t~ of Ftorida that 1~m filinp thit d~y in aaoord~~os ~nd
~n c~onformity with Chepter 222, Sectio~ 222,17, Florida Statut~s.
1 wes fo~merly a leflal resident of ~''L
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(City) (Stah)
and 1 ~esided at ~n~/~~~-~1 a~~~~ . However 1 haw char?~ee~ my domitile
(Snett a~d Number)
to and am end have been a bona fide ~esident of the Stah of Florida si~oe day of
/1~ Je-~~~~ , 19Z~ , and 1 roside at 6•?s~'~al.o~ rr ~G~ ~T OE~~'~
T (Street snd Numbsr)
FORT ri~CE, SAINT lUC1E COUNTY, RORIDA
and this statement is to be taken as my detlsration of citi~et~ship, attual le9al residente and domicile in the State of Horida.
(Insert here any pertinent facts, such as sale of propehy or business, or relinquishme~t of employment
at former domicile, removal af family to new domicile. purchase of home, etc.)
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I FURTHER CERTIFY that 1 w~ll aomply with all other requiremer~n of a leqal resident af this State.
I FURTHER CER7IFY that I have no intention to retum to my former domicjle, and I intend to remain in fORT
r
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~ ~ ~~rn a~~ ~
~ (Name) liaC~ll~
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~ (Address)
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~ Sworn to and subsuibed before me tfiis ~ day of `T~~ , 19
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~ ROGER ~pITRAt ~
CL~RK nRC~yIT COURT Notary Public
~ ~y . • , ' ~ D.C. My f.ommission expiras
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