HomeMy WebLinkAbout0970 ~(:2:)i( i ~
D~claration o! Oo~nicll~. and Citlssnship
TO THE STATE /1N0 ~OUNTY TAX ASSESSOR,
51. WGIE COUNTY, ftORIDA: -
This is my decla?~tion of Oomicile and Citi=~nship in th~ St~t~ of Flaid~ that 1~m filinq this d~y in aoo~~d~no~ and
~n co~formity with Chspte? 222, Section 222.17, Flotid~ Statut~s.
1 was formerly s le~sl residsnt of _ ~~oY•~UE1SG''C- , CAN~Up_
(City) ~ (Stah)
and 1 resided at /L pc= pY~ How~ver 1 have charpsd my domidl~
(Street and Numbe~)
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ro e~d am snd have been a bo~a fide ~esident of the State of Florida since ~ u day of
1~~ r1L3c R ,~q~Q, a„d ~ a, 0 4 G~ o2oNAno ~v~
~ (Stre~t and Number)
FORT M~CE, SAINT tUC1E COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal ~esidento and domicite in the Stste of Horida.
(Insert here any pertinent facts, such as sale of ~roperty or busi~eu, or relinquishment of employment
at fo?mer domicile, removal of family to new domicile, purchase of home, atc.)
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f ~Ep AND RECORpE
f~. WCIE COlIN1Y f~ ,
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~ I FURTHER CHtTIFY that 1 will aomply with all other requirements of s leqal resldent of this State.
~ I FURTHER CERTIFY that I have m intention to retum to my former domicjle, and 1 intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ ~~.{aM/9 sNa~ . ~fIN~S
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~ Sworn to and subxribed before me this ~O day of , 19.~.
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ROG(~~ ~l~I`
` . • Notary Public
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By ~.C. My Commission expires
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