HomeMy WebLinkAbout1491 Orcla~atio~ of pomlall• and Cltl=snship 2c :334~
TO THE STATE AND GOUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FIORIDA:
This is my declaration of Oomicile and Citizsnship in tM Sta~~ of Fiorid~ that 1~m fili~q this day in aooordanoe and
in conformity with Chapter ~22, Saction 222.17, Florids Statut~s.
I was forme~ly s legal ~esident of M~^~ ~ To N G~ '
(City) (Stats)
and 1 residad at ~
G~S ~~C ~~f ~y /2 A However I have charped my domic3le
(Street and Number)
to and am and hsve been a bona fide resident of the StaM of Florida sinoe 'S ! day of
~ .
_C~ , 19~V, and 1 reside at o~l~'D y~~iv VC2QI(//til `
(Street a~d Number •
I~ORT r1ERCE SAINT LUCIE COUNTY RORiDA T ~r C/ ~
. ,
and this statement is to be taken as my decla~ation of citizenship, actual legal residente and domiale in the State of Horida.
(tnsert here a~y peninent facts, such as sale of propsrty or bu:iness, or relinquishment of employment
at formrr domicile, removal of family to new domicile, purchase of home, ett.)
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sT~'~u°cAie" couM~r~t~.~
aocEa Po+s~u?a
RE~ppp YER ftEO c~T
~ ,Mu 15 It oM ~M'T1
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E I FURTHER CHtTIFY tha! 1 will oomply with al) other rsqui~ements of a lepa) ra'ident of thls State.
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t FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remein in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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(Name)
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(Address ~ ~
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~ Sworn to and subsuibed before me this -S day of , 19~.
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~ R~ ~r~ _
~r ~C~T Notary Rublic
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By ' O.C. My Commiuion expires
~t } '=o.si~ 1 : V
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y ,it' l
1AZ~'•:7 ~
s u
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- and orloinai Hl~d wi~b Cl~rlc Gra~if Cwe~, and dupliaN wilb Tax A~ora
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',-~t~r~ts ~~~t~t~,~: /~Q
~ ?+d- ~ a " ' : EQOK 189 PACE ~ `!~O
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