HomeMy WebLinkAbout1380 4 ~
o~cluatlo~ 0/ oomlcu~ a~d ~Itls~nship
TO THE STATE AND GOUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY. ~o~~o~: 2c3~2
This i: my detla~ation of Oo~nicile a~ CitisMShip i~ th~ S1~t~ of Florida th~t 1 am filinq this day i~ aooord~no~ ~~d
in conformity with Chapter 222, Sectio~ 222,17, Horida Statuhs.
I was formerly a leyal resident of ~ rJ~'~C ~~6L1~~K1dL~~ iVC~!!~. r%/~SE~
(City) (5tah)
and 1 resided at ~O O~ Nf' 7/T/~/t Kl /T:~~~ ~ . However I haw tharqsd my domWle
(Street and Number)
to and am and have been a bona fide rosident of the Stats o~f Florida sinoe ~ Z%!'~ day of
- . 19 , and ~ roside at ~ / T ~d5 /~l~~ ,,f
'T" ~~E~C /c._
(Shest and Nun~)
FORT NERCE, SAINT LtK1E COUNTY, RORIDA
and this statement i: to be taken as my declaration of citizenship, actual legal ~es'~denoe and domicile in tfie State of Florida.
~ ?
(Insert here any pertinent facts, such as sale of properry or business, or relinquishment of amp{o~rment
at former domicile, removal of family to ~w domicile, purchase of hon~e, etc.)
~LrGE DCO ~RT~ .
lOCf R ~TRAS
f.'lElK t11tCNlT~~
REfA'~O 1IERIf~
t3 ~~otAM'ZI
~y
~ ~ 203262
~
~
~
~ . .
~
~
~
~
~ I FURTHER CERTIFY that 1 will oomply with ell other requirsments of a 1 1 ~esidsnt of this State.
~
1 FURTHER CERTIFY that I have ra intention to retum to my former domicile, and I inter~d !o remain in FORT
PlHtCE, SAINT LUCIE COUNTIf, FLORIDA, permanently.
~
~ ~
~ lName)
- /~06 ~.-r S ~c
~
~
(Address)
~ ~ - . .
::t~:iliilt! .
~ , ; ~ +Y ~ f~ff
,'f before me thi: ~ ~ ~ 19 .
~ :j: ~d;)'~' .~~~l~ ~~l Of ~ ~
~ • -
. ~ , ~
' r--ti• ~ ~ • ~ ~ .
• : ft ~ :
~ ~ , _ .
~ t, y ~ Notary Pub1K
D.C. My C.o~rxnission ~xpir~s
~ B
~ y ~ - ' ~ G . _
~
~ R• b. .x.cre.d M dupuc.l~..~d .ri~iw.~ tiMd w~Mb u..k ci~aiN c.wt, .wd ~lie.~. wi* T.a~ A«.N..a
G~~
~o~K i89 ~~E 1377
~ i } ~
r
Y^~~,~' .a . 4 ~ r .
~"~~~~c~ ~
v~4~ ",:.T'.~~'~n.~~._ ~