HomeMy WebLinkAbout1400 D~ala~ation of ~iail~ and Citis~nship
TO THE STATE ANO COUNTY TAX ASSESSOR. ~
51. lUC1E COUNTY, FtORIDA: ~
~ 20327'6
This is my dscla~ation of Oomicile and Citlzanship in ths Stats of Flwida th~t 1 am filirq thi~ d~y in aooordano~ and
in co~formity with Chapter 222, S~ttion ?22.17, Flo~id~ Ststut~s.
I was formerly a legal resident of -lta~1~ _ ~ I• _
Ki~Y) (Sht~)
and 1 resided at _~S~ J~1~ However 1 hav~ chan~sd my domidle
~ (Street and Number)
ro and am and hsve been a bona fide ~eside~t of the Stats of Florida since day of
- . 19.~_, and I roside at ,ls ~2~ Haid
(Street and Number)
FORT riERCE, SAlNT LUCIE COUNTY, lLORIOA
and this statament is to be taken as my daclarotion of citizenship, actual lagal reside~ce a~d domicile in the State of Florida.
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(Insert he~e any pertinent facts, such as sale of proparty or busineu, or relinquishment of empl'oyment ~
at former domicite, ~emoval of family to new domicile, purchase of home, etc.)
b~st~ai
i1LE9 ANO RE~OR9E~
iT. UiC1E COIqlTY ft~,
CIf~CIRC~111T~CqStR
RECORO YERtf1E0.~'[ ~
~Mtl I~ IZ 11 PM'7~
2032~76
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I RIRTHER CERTIFY that I will aompiy with all other requiremeMs of e le~al resident of thls Stafe.
I FURTHER CERTIFY thst I have no intention b retum to my former domiGle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, fLORI~A, permanently.
(Name ,T~ha 1[~ Bsll
~
~ ~ Wddress)
.~~~.:~titi~ttrJ~f=
.ti~' ' i~ ~ i. . , ~ . ~
~t~/T+~-i~ ~ibed befors me thi: -,1~--? day of , 19~.
~ •:;~'~~~T~.!{'3•. V . .
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~ - •'~;_~~'"r~
~
~ ' t~tery Public
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6y. d D.C. My Commiuion expires
~ v ~ . L ~ ~•s ,
~ Ro b~ ~x~euNd in dvplicN~ and erf~inal Al~d whb CIMk qrad/ Co~r1, ~nd duplkah wiN~ Tax A~~a
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~ tGCI(~~7~7 PACE1397
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