HomeMy WebLinkAbout2611 O~aluatlo~ of ~o~niail~ a~d Citi=~nshlp
TO THE STATE ANO COUNTY TI1X ASSESSOR. ~~~4~
Sl. tUCIE GOUNTY. FIORIDA:
This is my decl~ration of ~omicils and Citiunship in th~ St~t~ of flo~id~ th~t 1 am filirp this dar in aooordano~ a~d
in aonformity with Chapter 22Z, Section 422.17, Florid~ Ststut~s.
1 wa: formsrly a leqal reside~t of ~O'~- J S I~ D I~7 _
- ~ (City) (St~i~)
and 1 ~esided at ~ 0~ _ ~ ~ How~ver 1 hsve chanqsd my danii3l~
(St~eet and Numb~)
to and am and have bee~ a bona fide_~esident of the Stete of Fiorida sinca ~~5~~~ day of
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~ ~ 7.>
(D C ~ S7~
~LJ i? ~ , 19
7, and 1 mside et y~~ ~ S •
(St~eet and Number)
FORT r1ERCE, SAINT LUCIE COUNTY, RORiDA
and this statement is to be taken as my dacla~ation of citizenship, actual legal residenoe and domicile in the Stat~t of F~ida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of Fwrr~e, etc.)
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1 FURTHER CERTIFY that 1 will aomply -with all othet ~squirements of a Ispal resident of this Stsh.
t FURTHER CERTIFY that I have no iMention to retum to my former domicjls, and 1 intend to romain in FORT
~IERCE, SAINT LUCIE COUNTY, FIORfDA, permanently.
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(Name)
~s~ ~y~ ~r ~ ~s s T
~ caaa~~s, Fr. Pi ~
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S wbsuibed before me this ~ day of - 19~
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_ : J ' '~t. .~IOf~~ Notary Public
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By `n ~ ~ D.C. My ~ommiuian expires
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