HomeMy WebLinkAbout2397 `~t )38U~
O~claratlor~ ot Oon~lall• a~d Citis~nship
TO THE STATE ANO COUNTY TAX ASSESSOR,
51. lUC1E COUNTY, FIORIDA:
Th~s is my declaration of ~omicila and Citise~ship in th~ State of Florid~ thst I am filinq this day in acaordanoe and
~n conformity with Chapter 222, Saction 22Z.17, Flaida Statutes.
I was fo~merly a legal resident of 1~S..~l~___ ~F ~ YaRI~'C
tCiy) (Sta»)
and 1 ~esided at ~s _Y ~/~L- /4U~ However I have chan~ed my domiCile
(Street and Numbe~)
to and am and have been a bona fide resident of the State of Flwida since ~~8~ lZ / day of
_ , 19~, and I reside at ~y1s .SO U 1
H~ R 1Y ~/~1V~ S 01~
- (Street and Number)
fORT MERCE, SAINT LUCIE COUNTY, fLOR10A
and this statement is to be taken as my declarotion of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here any pertinent facts, such as sale of properiy or busineu, or ~elinquishment of employment
at former domicile, removal c,f family b new domicile, purchase of home, etc.)
fi~oJ`~Esi ~ ~#I~ ~x~r~PTiaN
2U3805
FILfO ANO RECORa~
ST. ~OCERCPOITRAS ~
CLERK C~RCUIT COURT
RECORD YERIFIED
,lu~ Z6 il oo AN'ZI
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~ I FURTFfER CERTIFY that I will aomply with all other requirements of a lepal resident of this Stat~.
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~ 1 FURTHER CERTIFY that I have no intention to retum to my former domitile, and I intend to remain in FORT
g QIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently.
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~ (Name)
5
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a Sworn to and subxribed before me this day of , 19~L.
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~ . . ' Notary Public
~ e . D.C. My Commission expi~es •
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' , . • • ~ . _ ; V :
~ R~ ~N' ' ~ •nd oriQinal Abd wMb Cl~ek Ciraiit Cev~t, and duplicah wi1h Tax A~~aa
~ ~~"',-~n~_4 ~189 ~Q
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