HomeMy WebLinkAbout0971 ~Nr.~~"s
O~cluatlo~ o~ Oaniail~ a~d Citis~nshlp ~
TO THE STATE AN~ COUNTY TAX ASSESSOR,
51. LUCIE ~OUNTY, FlOR1~A:
This is my declaration of Domicile and Citis~nship in the Stat~ of Florida that 1 am tilitp thi: day i~ ~ooo~danw and
~n confo~mity with Chapter 22?, Settion 222.17, Florida St~tutes.
I was forme~ly a 1e9a1 reside~t of ~ M?~~ -,,~~~y~'l /GZ . _
(City) ~Statf)
and 1 resided at ~!l However 1 have tharqed my dornitjl~
" (Street s~d Numbet)
to and am and have been a bor~s fide ~esident of the State of Florida sinoe ~-'~1~~0 day of
- . 14 and I roside at ~
(Stree~ and )
FORT r1ERCE, SAINT LUCIE COUNTY, IRORmA
and this statement is to be taken as my daclaration of citizenship, actual legal residenos and domiale in the State of florida.
(Insert here any pertinent facts, sud~ as sal! of propsrty or business, or relinquishment of ernpto~?ment
at former domicile, removal of family to new domicik, purchase of hane, etc_) ~
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E CO{iMT1~
CtER~ C RCt~fIT~=
R[CORO YE~tIf1E0
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€ I RIRTHER CERTIFY that 1 will oomply wifh all o~ requiree~enis of a(epal residant of this State.
t FURTHER CERTIFY that I have no intention to retum to my former domecjle, and I inte~d to remain in FORT
r
~ PIERCE, SAINT LUCIE COUNTIf, FIORIDA, permanently.
6 ~;'i "•~_Y.
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~ ~°''..~vj~Y~ ~OC~~'~wbsuibed before me this ~ day of 19~.
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~ ROGER rORRAf
~ C.LERK CIRCWT ~OURT Notary Public
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~ By O.C. My Commission axpres
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~ Ro b~ ~x~cuNd in duplical~ and ~al fil~d w116 CIMIc Cira~if C«rrt, awd drplic~N wilb Tax AN~r-1
~ OR
- , ~ go~K 189 ~E 96$
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