HomeMy WebLinkAbout0938 D~cla~atio~ ot Oomlali~ arn! Citis~~ship
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TO THE STATE ANO COUNTY TAX ASSESSOR.
Sl. lUC1E COUNTY, FIORIDA:
This is my declaration of Domicile snd Gitiz~nship in the Stat~ of Florida that 1 am filin~ this day in aooordano~ snd
~n conformily with Chapter 222, Section 222.17, Florida Statutes.
I wes forme~ly a leyal ~esident of ,
(Ciy) (Sta»)
end I resided at y- Iv_~ ` Howevsr I hsve chan~ad my domic,~le
(Street and Number)
to and am and hsve been a bona fide resid~nt of the State of Florida since ~/1 dsy of
~
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_ , 19~~, and 1 roside st
(Sheet and Number)
FORT M~CE, SAINT WCIE COUNTY, RORIDA . ~
and this statement is to be taken as my declaratio~ of citizenship, actual legal residencs and domicile in the Stats of Florida.
(Insert here any pertinent facts, such as sale of propernr or business, or relinquishment of employmant ~
at former domicile, ~emoval of family to new domiale, purcfiase of home, etc.)
~E~ ~w0 R~ ~
S~.l1iC1f GO~~~' '
iIOCEN P01j~~a
IlEC0a0 rlaiMEO C~Rt
~ 5 g ~ P1~'11
202950
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~ I FURTHER CERTIFY that I wil) comply with all other requiremenri of a(egal resident of thi: State.
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~ I FURTHER CERTIFY that I have no intention to retum to my former domicjle, and I intend to remain in FORT
~ PIERCE, SAINT WCIE COUNTY, FIORIDA, permanently.
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(Name)
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~ b~k,prF~!f~~r~f;~( ~Y,.ubscribed~before me this ~ day of , 19~.
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~ ~ • ~~E CI~d11RT. Notary Public
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~ y~ , D.C. My Commission expires
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~ Re .~oneuhd in dvplicat~ and ori~inal Al~d wi1i~ Gwlc CirwM Ceurt, and duplicaN wiM~ Tax As~or.)
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