HomeMy WebLinkAbout1253 i
o~luatio~+ of Oanlail~ a~d CltlsMShtp ~
TO THE ST/1TE AND COUNTY TAX A?SSESSOR.
51. lUClE COUNTY, FtORIDA: ~Q~"~4
This is my detlaration of Oomicil~ a~d CitizMthip in th~ Stat~ of Horida that 1~m fil9n4 this d~y in aooordino~ a~d
in conformity with Chapter 222. Ssctio~ Z2~.17. Florida Statut~s.
1 was formerly a layal residtnt of ~ Q -
_ KitY) _ ah)
~ l G However 1 haw cM m domidle
and 1 resided at - ~Wed y
_ (Stre~t and Number)
to a~d am and have bean a bona fide r~ident of the StaM of Florida sinoe day of
0' ~ c~+~ ~ i~~~~'S/fl"lrcc~ ~tc-P .
- - , 19~, end I es~de at ~ ,
(Stroet and Numbsr)
EORT M~E, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken ~as my daclaratio~~ of citizenship, actual legal residenoe and domicile in the Stat~e of Horlda.
(tnsert hero sny pe~tinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family ro ~ew domicile, purchase of horrie, etc.)
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~ 2Q31'74
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~ 1 FURTHER CfRTIFY that 1 will aomply with all ott~ nqulrem~nts of a lepal rssldsnt of this State.
1 fURTHER CERTIFY that 1 havc no intention to retum to my former domicyle, and I intend to ~emain in FORT
PiERCE, SAINT lUC1E COUNTY, FLORIDA, permanently.
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~ ~a ~~O ~O/~s~
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~ . , _ (/i??ddress)
.
~ ;,`~tit1••:ii,ii/~~` q .
~ ~`~4 ,~!qfR~C~d~~~saibsd before me this day of c~ !r- , 19~
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- ' ~OI~T Notsry Public
~ , ~
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_ By ~ ' , O.C. My Gommiuion expir~t
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.
lTe b~ ~x~c~ iA d~p~caa ana arioiwal AMr wM~ CMrit Cb~wM 4w~. ~nd ~ wNi~ Tax A~J
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