HomeMy WebLinkAbout1105 D~aluatlon ot Oomlali~ +u~d Cit~MShip
TO THE STATE AND COUNTY TAX ASSESSOR. . 2(~ AO~~ .
a)
Sl. ltJC1E COUNTY, FIORIGA:
Thit i: my dsclaration of Oomicil~ and Gitis~nship in ths St~t~ of florid~ th~t I am fili~q this day in aoootdanos and
in ow~formity with Chapte~ 222, Ssction 222.17, Florid~ Statuh:. ~
I was formeriy a le~al rosident of /y~~~~~
(City) (51~h)
and 1 residad at _~Y~ Howtver 1 hsv~ charp~d my domidk
(S t and Numbe~)
to and am and have been a bona fide ~esidant of ths Stats of Florida ainoe day of
_ , 19___~L} and ! ~esids at ~O ~ ~o ~ 3 ~ c~ / .
(Street and Number)
FORT r1~CE, SAINT LUCIE COUNTY, RORIDA ~ .
and this statement is to be taken as my declaration of citizenship, actuati legal residenas and domidle in ths State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employme~t
st former domicile, removal of family to new domicile, purchase of home, etc.)
~-~~!'-~tC~R QO ,
~ r1lE~ AND RE~QRe~
ST. LIICIE COUN ~ t f
~ ROCER POItMS
CLERII CIRC{IIT C8U T
- IIECORO YERIFlEO
J~ l ~4 ~s PM'TI
€ 2030`72 ~
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~ I FURTHER CERTIFY fhat I will aomply with al) ofher roquiremenK of a le~al rasid~nt of this Stats. ~
I FURTHER CERTIFY that I hava no intention to retum to my fo~mer domitile, and I intend to remdin in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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; N ~ ibsd before me this day of ` , 19 .
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~ ,f~ ~d~'~~ -COURT Notary Public
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~ By ~ D.~. My Gommission expi~es
Re b~ uc~cubd in d~ sad ori~i~ Hl~d whh Cl~ek Ci~it Cowt, aed d~plkal~ wNh Tax A~w~a
~ „ 6oQK 189 1102 .
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