HomeMy WebLinkAbout0983 2t )2~~3:'~
D~ciaration ot Don~icll~ and Citi:~nship
TO THE STATE AN~ COUNTY tAX ASSE5SOR, ~
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Sl. lUC1E COUNTY. fIORIDA: ~
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This is my detlsretio~ 'of Domicile snd Citiz~nship i~ th~ State of Flotid~ that 1 arn filin~ this day in socordano~ and
~n co~fo~mity with Chapte~ 2~2. Ssction 422.17. Florid~ Statut~s.
1 was fo~marly a leqei ~esident of ~ A S T__~CL!L! ~~s-- - C1 ~/1/ ~ _
~ (City) (Stah) .
1
a~d ~ res~ded at ~Z ~R y How~vsr I have charpsd my domiGle ~
(Stroet and Number)
ro and am a~d have been a bona fide resident of the State of Florids sinc~e day of
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, 192~, and 1 rsside at ~ 0 02 1L t~ll.f A•- ~T~ pf f~C,F
(Street and Number)
FORT r1ERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citize~ship, act~al legal ~esidenoe a~?d domicile in the State of Florida.
(Inse~t here any peninent facts, such as sale of property or busineu, or relinquishment of employment
at former domicile, removal of family ro new domicile, purchase of home, etc.)
202~85
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CPQITR~
CLERK Cf~U1T COURf ~ ~
IIECORD YE~tI IEO
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I RJRTHER C~RTIFY that 1 will oomply with al) ofher requirements of a Ispal resident of thls State.
I FURTHER CERTIFY that I have no intention to return to my former domicjle, and f intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. C~ QSfe np~ J~
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(Name)
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~ Sworn to ~nd subsuibed before me this ~ day of , 19~.
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By ~ ' D.C. My ~ommiuion expires
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