HomeMy WebLinkAbout1059 O~aluatio~ of Danlall~. a~d Cltis~nahlp
TO THE STATE AND COUNTY TAX ASSESSOR.
Sl. ltJC1E COUNTY, fLOR10A: ~~~4a3
This is my dects~ation of Oomicil• ~nd Citiuruhip in th~ State of Florida that 1~m filin~ this day i~ ~d~~a ~nd
in oonformity with Chapter 222. S~ction ?22.17, Fiorid~ Statut~s.
1 wa: formerly a Ipal resid~nt of
~y) (St~1~)
and 1 resided at Z`r y /~7 ~ l.~~.~t -/~l..a
9t l~-.~ . Howtvtr I havs tha dom le
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b and am and have been a bona fide residant of the Stste of florlda :inoe 3 day of
~ . 19~.s2, and 1 roside at 30 /~+A. ~
~ (Strset a~d Number)
FORT M~C~. SAlNT LUCIE t:OUNTY, RORIDA
and this stateme~t is to be t~•ken as my decisration of atizenship, adual lasal reside~os and domicils in the SMte of Horida.
(Insert here any pertinent facts, such as sate of property or business, or roli~quishmsnt of employment
at former domiale, r~,rrwval of family to nsw domiale, purchase of Fwme, etc.)
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~ I FURTHER CERTIFY ffiat i will oomply with ail othar ~equi~sm~nts of a lepal nsidsnt of this Stah.
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~ 1 FURTHER CERTIFY that I have no intention to retum to my former domitile, and I intend to remain in FOR7
PiERCE, SAINT IUCIE COUNTY, FLORIDA, permanently.
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~ j .-v~f~,~,?.lu«~i~d substribed before me this day of ~ 19
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" ~T Notary Public
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~ BY' ~.C. My Gommi:sion snpires
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R. b. .oc~M.i iu dirpik.~. .n~ ..foiwal AI~ wr11~ a«t cMaiM C.w+, ,wa drplie.t. wiN~ T.x A...M..a
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