HomeMy WebLinkAbout1085 Y~"
O~cla~atlon ot Domlail~ a~d CitisMShi~U~S`.~
TO TNE STATE AN~ COUNTY TAX ASSESSOR,
Sl. U1CIE COUNTY, FIORIDA:
This is my dacluatio~ of Domicile and CiNsMShip in th~ St~» of Horida that 1 am filinp this day in ~aoordano~ a~d
in oonformiry with Chapter 2Z~, Settion 22Z.17. Florida Statut~s.
i Wa: ~~.iY . i.~i .~~d«,r of 1~.TZ 2hGE 'PA ~ k dN ~ o
tr~ty) (Stat~)
and 1 resided at ~ O q M~a R r~? N~ A IJ E . However 1 have ch~npsc! my domiale
(SheN and Numbe~) .
to and am a~d have bee~ a bona ficie rosid~nt of the State af Florid~ si~ 2 U day of
~~L ~rM i'i ~ ~2 , 19~, and I~id~ at 1 dq ~ STI A ~ ~l 1.1 C.
(Street and Number)
I~ORT M~. SAlNT LUGE COUNTY, lLOR~A .
and this stateme~t is to be taken as my dedantio~ of atinenship, utval le~aat reside~+c~e and domicile in the State of Horida.
qnsert here any pertine~t fads, such as sala of pnoperty or business, a~i~quishment of ar?pla~rment
st former domicile, r~errwval of family to new domiciie, purd~sse of home, etc.)
~O NtE S EA t~
. 20 3059
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~u~C1E CQUMTY ~tA.
ROCER ?WTIIA: .
CIERN CIRCWT ~
11ECOR0 VERIFIEO
Ju~ 1 I s9 PM'TI
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~ I FURTHER CHtTIFY that I will oomply with all otl~x nquirarrwnts of s{epsl r~sideM of this Stah.
1 FURTHER CERTIFY that 1 have no inte~tion ro retum to my former domic,~le, and 1 i~tend to ~emain in FORT
PIERCE. SAINt L~tE COUNTY, FLORIDA, permanentty. CeRROLI, w. TY~ .
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~iorrl,lA~~,b~ibsd lxf.ore me this ' day of . 197 .
RO~ ~'OiTRAf
CL~RK pRt1NT Notsry Publk
By ~ O.C. Mr C.onxnis:ion expi~
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tT~ w~ 1w ~+'licat~ ~ K1~M~1 Hi~r wMl~ Cla~k Gewiit Gwt, a~ d~a wiN~ T~c A~w~a
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