HomeMy WebLinkAbout1255 u°
O~al~ratio~ ot Do~lail~ a~d Cit~~nship
TO THE STATE ANQ COUNTY T/1X ASSESSOR,
51. lUC1E COUNTY. FIORIDA:
This is my declantion of Oomicil• a~d Citirnihip in th~ State of Florida that 0 am filin~ this d~y in aooo~dano~ and
~n oonformiy with Chapter 222, 'Section 222.17, Florida Statutes.
I was formerly a le9al resident of - --I~~
( ) tah)
and 1 residad at ~ ~ However 1 have chsn~sd my domidla
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- (Strest and Number)
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to end am and have been a bo~a fide resident of the State of Florida s+noe ~ ~ day of
_ , 19 , and I reside at 2iYS.- Iy E S@~, L~ ~~/l.Vtf ~
~ (Street and Numbst)
FOltT MERCE, SAtNT LUCIE COUNTY, RORIOA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domiale in the Stste of Horida.
(Insert here any pertinant fads, such as sale of property or business, ~ relinquishment of employment
at former domicile, removal of family to new domicile, pu~thase of home, etc.) ~
~
.ED
FiLEO ~w0 RfC - ~ t ~R. .
S~.IUGE tOttli'~f~. - ~
IIOCER F01?itAi ~ - ~ , R ~
tLERi~ ~IRCWT ~OrllT„~.~
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I RJRTHER ~ERTIFY that I will oomply with all other requi~emenri of a~ leqal resident of thi: State.
I FURTHER CERTIFY that I have ~w intention to retum to my former domi4le, and I intend to remain in FORT
PIERCE, SAINT LUCIE COt1NTY, FLORIDA, permanently.
1
~ ~JI~~R, ~ _1~ ~c ~ `d~n,~ c_e1~
~ (Name) '~1 Qc~: t+
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~ . (Address) ~y~' P L 21~ Q,
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it~111i711iIJ/;~~ . '~r.,
-`~i.~~A~d~{q,t~ct~bsd before me this day of ~ - , 19-~L~
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- By 'f` ' O.C. My Commission expires
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(Te b~ ~aaaM~i iw duplicat~ and erioinal Al~d wilb Cl~k Circub Co~~t, and duplkat~ witi~ Tax A~~.)
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