HomeMy WebLinkAbout2420 D~clar~tlon of ~o~nlail• and Citia~nship
TO THE STATE AN~ COUNTY TAX ASSESSOR, ~
Sl. lUC1E ~qUNTY. FIORIDA:
This i: ~rsy decterstion of Oomicile er+d Citiunship i~ th~ State of Florid~ that I~m filir~q this d~y in ~cco?da~a ~nd
~n conformity with Chspte~ 222, Section 2?2,17, Flo~ide Statutes.
I was formerly s legal ~esident of _ r ~ ~ ~ S _ _ ~ O •
(~ity) (Stah)
and 1 ~esided at / ~_.~C~~/~ l.l~/ C' E~ w v v
~ Ho e ar I ha e chan~ed my domic,ile
(St~eet a~d Number)
~ t~C
to and am and have been a bona fide resident of the State of Florida since day of
L . 19 , and I roside at ~ 3~~ r, ~E E K~oo a~ .
~ ~ (Street and Number) ~
fORT NERCE, SAINT lUC1E COUNTY, RORlDA
and this statement is to be saken as my declaratio~ of citizenship, actual tegal residence and domicile in the State of Horida.
(Insert here any pertine~t facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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=T IUCfE C01lNrr Fy,
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~ I FURTHER CERTIFY that 1 will oomply with all other requirement~ of a le~a) resident of this State.
~ I FURTHER CERTIFY ihat 1 have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SA11~1`.~UCIE COUNTY, FLORIDA, pe~manently.
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~worip ~fo~and subxribed before me this ~ day of a~"""- , 19
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ROGER rO1TRA5
~ CIRCUtT COURT Notary Public
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8 D.C. My Commission expires
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(To b~ tx~t~d in duplicat~ and o~inal fil~d wha Cl~rit qra~}f Co~r~t, snd dvplicN~ wi1i~ Tax A~t~er.)
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No. i3
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