HomeMy WebLinkAbout2077 O~aluatlo~ ot Oomlau~ and Citts~ahip
TO THE STATE ANO COUNTY TAX I155FSSOR. 2Qa~j~1
Sl. tlK1E COUNTY, FIORIDA: .
Thi: is my decl~ration of Oomicil~ and Citiun~ip in tht St~t~ of H~ida that 1 am filinq this day In aaoordana a~d
~n oonformity with Chapt~? 422. S~ttion 222.17, Horida StafuNs.
1 wss forme~ly a Ipal nsident of ~ ~
( I tSUt~)
and I residsd at i~ ~~~'~UJ~C.C G~~ . Howewr 1 haw d~arped my domkil~
(Stt~et a~d Numbe~2
to and am and hsve been a bc~a fide ~es'~dent of the Stah of Fbrida since day of
, 19.~~, and 1 reside at ~
(Str~t and Numb~~)
FORT M~CE, SAINT LUClE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizeoship, actual lepai residenoe ~~d domiat~ in the Shte of flotida.
pnssrt here any pertinant fads, such as aafe of property or business, a~ relinquishmsnt of ~mpioym~nt
at former domicile, removai of famlly to new domicik, purchase of hane, etc.) _ -
~l~L~~A~
~~~o ~c r~ ~
RooEa pat~u?s
~IERt CiRqNT CO~T ~ ~J -
REOORD YERlfIfO~.~ y
i
,M~ 2~ II 4? ~f'Z~
2C~359i,
.
f I FURTHER CHtTIFlf that 1 will aomply wNh al) ofhe~ r~quirom~nb of a Ipal nsid~nt of this ~ab.
~ .
4 . .
~ ~ 1 FURTHER CERTIFY thae I havs no intention to return to my former domiale, and I intend to remain in FORT
j PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
6 ~
~
i .
~
i ~ ~
i ~
~ ~~Q hr/i?t ~ ~Q ~L,L t <i ~
~
~ .,,~:t~iiiflrr~~
~ r~~
F `~~``Vti+ ~lCG/~1~ ~
` { ~ ~csod~s~fb~bed before me thi: °2 / day of 19~
~ 't iP.~^' ~i': s s~''-
e a ~ t,.'j' ~Q : ~ .
~ = j~ ~~~~`-dJ?'a~~ G ~ r
~k ~ - ~
T. .
f
~ ~
a;
: . _ ~ . - Notary Pubiic
~ ~ .t~:
~ . ! .
~ By ~ ~ 0.C. My Commistion ~xpins
,
•...;1~~ ; ' ,
~ ~ ,
~ -Y~Y'
~ (TO ~li ~ ~II a/M~
~ drpus.t~. «ian.~ A,.a wMl~ a«k ckarb cewt, .~d dn~liat. ,~rilh Tax A~......a
~ aoo~i89 P~~20'~0
~
, - ~ ~ , s ~
~ .
= -