HomeMy WebLinkAbout1773 O~cla~atlo~ ot Do~nlall~ a~d Clt!=~nship
TO THE STATE ANO COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FLORIDA:
Thii is my decla~~tion of Oomicils •nd Citiunihip in ths St~te of Florida th~t I am filin~ this day in aooordanq and
in oonformiy with Chapter Z22, Section ZZZ.17, Florids Statutes.
1 was formerly a Isyal ~esident of , ~ D ~1 % D
( ) (Sta»)
and I residsd at _ ~ R- . However I hsw chanqsd my domicale._
(Sfraef and Nuntber)
to end am and have been a bona fide resident of th~ StaM of Florida since ~ y~ day of
-~~~_'f , 19~~ and I roside at ~ D O 9 ~ I' D t~ t fo~ ~iti ~
{Street a~d Number) -
EORT MERCE, SAlNT LUGIE COUNTY, RORiDA
and this statement is b be taken as my decia~ation of citizenship, actual legsl residenoe and domicile in the State of Horida.
(Inse~t here any pertinent fects, such as sale of property or business, or relinquishmant of employment
at former domicile, removal of family to new domicile, purchsse of home, etc.)
~1~~~..~~G
203522
FtlEO ~~D~~~COItDEO
ST.IUC~E COUNTY flA.
- ROCER PO~TRAS
CIERK GIitGU1T COURT
RECORO YEitIF1E0~.~..~~ .
Jar+ ZO 9 ~N'T I -
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~ I FURTFIER C6RTIFY that I will oomply with all otFwr requirem~nts of a leqal r~sidsnt of this Sta».
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I FURTHER C~RTIFY ihat I have no intention to retum to my former domic~le, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ t~,~i~OrrAB ~~?id. su~iscribed before me this day of 19 .
~ . , _
~ ROGER rO1TRAS
~ CIRCWT OURT Notary Public
~ ~
~ gy D.C. My ~ommission expires
Re b~ ~x~cvhd in dupliwl~ and oei~inal Bl~d wMb C{~k Ci~arif Couef, aew! dupuat~ wi16 f~t As~e~.1
~ , ~ Q~K189. ~~~.7~8
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