HomeMy WebLinkAbout1061 ~ Olala~atlOf! Of OO~niail! alid CltltMSll~p
TO THf STATE ANC COUNTY TAX ASSESSOR,
Sl. U1CIE COUNTY, FLORIOA:
Thi: is my declar~tion of Oomicil~ ~~d pti~ship in th~ St~t! of Fiorida that I am filinq this d~y in ~aoo~d~na and
i~ oonformity wiM Chapter Z2~. Section 222.17. Florida Statutas.
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I was formsrly a le~al rasidsi+t of
(Gh) ~ (St~t~) .
end I resided at ~1.L ~ Hovwver 1 Mw thanped my dOmiCik
(5tnsf and Numbsr)
ro and sm and have been a bo~s fide nsidsnt of the Sht~ of Harida sinoe - ' O day of
, 19~0 and 1 roside d~~ ~ _
(Stnst and Numbe~)
FORT ~I~C~, SAINT UlCIE COtINTY. l~L+ORDA
and this staternent. is to be taken as my dedaration of ati~anship, actual IeQal r~sidenos snd domicik in th~ State of Horid~.
pnsert here amr pertinent facts, such as sale of property or bu:iness, or mlinquishment of amployment
st ~msr domicile, romoval of family b new domicile, purchas~ of hon~e, etc.)
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~ 1 FURTNER CBtTIFY that I will camply wlth all oRt~ c~quinrr~h of a Ipal ~t of tfii: Stat~.
1 fURTHER CERTiFY thst I have no intention to returri to my former domic~le, a~d I intsnd to romsin in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ _ . Sworn tg and wbxribsd befor~ ms this " ~ dar of ~ , 19
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