HomeMy WebLinkAbout0974 ~
~claration ot Oomiafl~ a~d Citis~nship
TO THE STATE AN~ COUNTY TAX ASSESSOR, !2~~sO
Sl. WCIE ~OUNTY. FIORIDA:
This is my declaration of Domicile and Citizenship in th~ St~te of Florid~ that 1 am filin~ this d~y in aooordano~ snd
in tonformity with Chspter ?22, Section 222.17, Florida Statutes.
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I was forme~ly a 1e9a1 resident of ~0~~ ~
(City) (Sta»)
and I resided at ~~j~ ~ y T'~ d TR~~T F~- ~s~!!~~wever I have chanqed my domiqils
(Street and Number)
to a~d am and have been a bona fide reaident of the State of Florids since ~T~ day of t
~ J J'AC~ ~'~f~i!1~,~ ~11~~ ~
- . 19 and 1 reside at
(Street and Number)
FORT MERCE, SAINT LUClE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residenoe and domicile in the State of Florida. ~
(Insert he~e any pertinent fads, such as sale of property or business, or relinquishment of employme~t
st former domicile, removal of family to new domicile, purchase of home, etc.)
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~rjZ ~.~'~t?'<, ~~i~ °e'~' ! Gs~~ .
F l~0 #MO RfC_QRpiO
a~ LUCIE COUi1T1? fL~.
IIOCER POITqA=
~ECORD YER FI~E"pT
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~ I RJRTHER CERTIFY that I will comply wiffi all other ~squirements of a le~al resident of thi: State.
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~ 1 FURTHER CERTIFY that 1 have no intention to return to my former domiCile, and I intend to remain in FORT
~ PlERCE, SAINT LUCIE COUNTY, FIORIDA~ permanently. -
~ ~ ~ 2~2- ~ 1,G__ _
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s (Name)
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~ ;•y~3~~'~p~'stibscribed before me this day of ~rt ~ , 19-..~
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~ CCNRT Notary Public ~ f
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By ~ D.C. My Commiuion expires #
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~ tTo b~ ~x~evt~d in e~upfieat~ and o~inal fit~d wilh Cl~ric pra~it Co~rN, and duplieah with Tax A~~o~.)
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~ gooK 189 P~E 97 ~
~ No. 13 _ ~
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