HomeMy WebLinkAbout1627 Osaluation ot ~omlail• and Citis~nship
TO THE ST/?TE AND COUNTY TAX ASSE550R. ~~34~3
Sl. tUClf COUNTY, FIORIDA: ~ .
This is my declara~ion of Oomicil• a~d Citiunship i~ th~ State of flprid~ th~t 1 am filin~ thii day in ~ooord~no~ ~nd
~n tonformity with Chapter 222, Section 222.17, Florid~ Statut~s.
I was forme~ly a Is~al ~esid~nt of ~-A'~~~ ~ -
(Ciy) (Stai )
a~d I resided at _~~s 3~ ~~~t,~~ 2~~.! . . However 1 have chan~ed my domic,ile
(Sheet snd Number) ~ ~
to ar~d am and have been a bw?a fide ~esident of ths State of Florida sinas ~ day of
, 19~, and 1 roslde a~~'~'a GG~G ~ o~ O
' (Sheet anc! Numbsr)
FORT M~CE, SAINT lUC1E COUNTY, RO~tDA c~ / F~ Ct
and this statement is to be taken as my declaration of citizenship, actual le9al ~esidence and domiclle in ths Stats of Horlda.
(Inse~t he~e any pertinent facts, such as sale of property or busineu, or relinquishme~t of employmant
et former domicile, removal of family to .new domicile, purchase of twme, etc.)
~D AM~ ltECOROE
ii ~{Klf ~~Mn F~
~~R Pomus
C~ERIt C~RC1l1T~~c~ _
~ RECORD rE1t1F1E0
~ ~Q ~ ~
203443
~
~
f
l
~
~ ~
1 RIRTHER CERTIFY that I will oomply with all other roquirements of a Ispa) resident of this State.
1 FURTHER CERTIFlf that 1 have no intention to returr~ to my former domiCile, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~
~
~
~ ~j/e,~-t J R ~//e.v
~ ,~;;,:::t~r:i~;, . _ - .
# ; •:%=1i i ~G~i,~ ~
~ ~ J~',~;j,j: Va~i~~.,' ~x+df~Sf)
~ • i ~s - (.C~G
;I~ ~
. ~i;: .
~ ~ ;j :yj~ =j.` G;~ ~
~ ~ vSMratf tb irid ~a~suibed before me this day of , 19.~
. t
= ,.:;.~z` : Q.;
. _ ~ v
~ . ; ~
~ {l
~ C;
~ r.~~~C~NR COt~T Notary Public
,
By D.C. My Commis:ion expires
~
.
(Te b~ ~x~arhd ie duplicN~ awi ~lotw~l 1~ wNM Clwk Ci~M Cwr~, and d~plleal~ whb T~x As~e~a
~
~ ~i89 ~i~ _ _
. : ~
~ s . ~ :x _
, Y