HomeMy WebLinkAbout1058 O~cluatlo~ o! Oomlall~ aMt Citis~nship
TO THE STATE AND COUNTY TAX ASSESSOR. 2Q3442
Sl. LlJC1E COUNTY, FIORIDA:
This is my decluatiors of Oomitil~ •nd Citinnship in tM St~ts of Flarid~ that 1 am filinp this day iR aooordano~ ar+d
in aonformity with Chapter 22Z, Sattiw~ Z22.17, Fbtid~ StatuNs.
~ .
I wss formarly a Ipal residsnt of ~
(City) (Ste»)
and 1 resided at wevK 1 haw thsrqed my domic~le
(St~eet and Number)
ro and am a~d have bee~ a bona fide resident of the Sht~ of Florida sino~ day of
- . 19 , and 1 rosid~ at
- (Streaf and Numbsr)
fORT M~C~. SAINT L11CIE COUNTY, I~LORIDA
and this statsment is ro be take~ as my deciaration of citizenship, actual Ipsl ~esidenoe and domicil~ in the State of Horida.
pnsert here a~y pertinent facfs, such as sale of property or business, or mlinquisfiment of employment
at fonner domicite, romoval of family to new icile, purchase of lame, eTc.) ~ .
iT. IlOAER
Pa1TM~~
C ERK CIR~t
~ ~E{~!0 YERIf1E~ ~
~ ~ ~ ~0 ~'Z~
203042
~
;
~
~ - -
~ ,
~
~
! FURTHfR CERTIFY that I will aomply with sll othsr requiren~nts of s lepal residsnt of this State. -
I FURTHER CERTIFY that I have no intention b ~etum to my former domicyle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~ .
c
(Name)
x ':~rs.=~
=•j ~ ~
~ ~~;~??~nnui~j%~ ~ ~ (Address)
~ `~?r,~ ~
. ~~•N~~•O~ . _
~ t
~ , ~ i ~•VV~ • / ~1 .
~ ~ + fi
~,~~~sd before me this day of 19~
i Q ~i._- ' ~
~ ~i p ~ a..
~ ~~:J C~:~~y~:
~ M • l 4 • .
t : ~ ~ ~
t •
~ 1
I ~ rt ~ ~
; .
~ ~ Notary PuWk
~ = -
" , - C
~ 8y O.C. My Commission ~xpins
~ -Y ~ -
~ R~ M~aart~d tw drpkcah awi «~i~inal A!~ wiM~ Chelc Cie+aiM C~w~ and wilb T~c f1~~
~ . a
~ ~anKiss ~ -
_
~ - ~~~r~~~