HomeMy WebLinkAbout1062 O~alaratioo~ 0/ Oo~nlail* aM! CItlsMShip
TO TME STATE AND ~OtJNTIf tAX /?SSESSOR. ~
Sl. ll1~lE @OUNT1f. KORIDI~:
Thi: ii my decl~~~tion of Oomicil~ ~~cl Citi~nship in th~ Stat~ of Florida that 1 am filinq this d~y in aooord~no~ and
~n oonformil~r with ChaptK 222. Ssttion 2ZZ.17, Florida SistuNS.
I was fonntrfy a lpel resid~nt of ~ -
) (Statr
and 1 rasided at j~- ~ - ~ . I~bw~v~ 1 haw ttwrq~c! my cbrnic3l~
(5tnat ~nd )
ro a~d a a~d have bsen a ba?a fide rosida~t of the StsN of Florids sinoe ~ day of
, 19~1L, and { ~id~ at 3
(5troet and Numbsr)
1~ORT SAWT L1lCE COtMRY, l~ORq~
and this stateme~t is ta be taken as my dodaration of ati~enship, adual Ipal residencs a~d domicik i~ the Stst~ of Horida.
pnsert here any pertinent facts, wch as sale of poopsrt~r or busin~ss, or rclirx~uishment of ~+ploy~r~ant
at former domicile. ~en+oval of fannily to ~ew domicik, purchase of Fwrne, etc.)
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1 FURTHHt ~HtTIFY tfiat 1 will oomply with sll otF~ nqul~ts of a Ipal ~idsnt of thi: Stat~.
I FURTHER CHtTlFY that I have no intention to my former domiqle, and I intend to remain in FORT
PlERCE. SAINT LUCIE COUNTY, FLORIDA, permar~entl .
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~ subKrib~d before me ftlis day of
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