HomeMy WebLinkAbout1088 D~Clal'i410f1 Ot 00111~C1l~ a111~ CI~NIi~11~f
TO THE STATE M1D COUNTIf TAX ASSESSOR,
Sl. UJCIE C0IJNTY. FLOitIDA: 2030~Z
This is m~r d~cl~r~tion of Domial~ and Citinn~ip in th~ St~t~ of Norid~ that 1 am tilinq this day in ~ooordar~c~ and
in oonformity with Chaptat 222. S~ction 222.17, Florida StatuMs.
1 was fonne~ty a Is~al ros~t of ~ ~ G
(City) . at~)
and 1 rosided at Gl~m ~-rt ~ sZ- . Flow~vK I haw thsn~d my domiGle
~ (Str~t and Number)
to ~nd ~m and Mva bean a bo~a fid~ rosidsnt of the Sta1r of Florida sinoe -~G~ ~ dar of
_ 19 7~, and I roside at ~7 s~
~t and Numbsr)
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PORT t~E, S~AN~IT LIK~E CO~N~ITY. ~A
and this stateme~t is ro be taken as my dedantion of dtizenship, actval le~al residenos and domidle in tfie State of Horida.
pnsa~ here a~y pemnent faas, such as sale of property or business, or relinquishn+ent of employmsnt
at former domicile, romoval of family to new domicik, purchase of honr~e, Mt.1
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sfi~.i~~ cou~
~ocFa Pat~u?s
CiERR 61RGWT
RECOltD tlER1F1E0
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I fURTMER ~HtT1Flf that 1 will oomply with all ather requinm~nts of a le~al res~de~t of thk Stat~.
1 FURTHHt ~ERTIFY that I have no intention to retum to my former domicjle, and 1 intend to remain in FORT
PIEitCE, SAINT U1CtE COUNTY, fLOR10A, permanenNy.
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~i~ibsd before mt thi: day of 19~
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a ` ~ O.C. . My Commttsion txpins
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