HomeMy WebLinkAbout2658 D~cluatlon ot Oorniatl~ a~d Citt=~nahip
TO THE STATE ANO COUNTY TAX AS565SOR, .
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51. lUC1E COUNTY. FIORIDI?:
Thi~ is my dsclar~tion of Oon~icilr and Gti~nship in th~ St~t~ of Florid~ ihat I~n+ filin~ thia day in ~ooord~na ~nd
i~ oonformily wtth ChaptK 22Z. S~ttbn 222.17, Florida St~tutsa.
1 was formerly a Ip~l nsld~nf ~ 1~'~? ?~~e1C Cit~ 1~ Y~t
Kih~
~nd 1 raid~d ~t ~~s! i4~~ sis~ri Howww 1 hav~ cfiarped my domWl~
(Stn~t and Numl~e~)
to and am ~nd h~vs be~n • bona Kds ~id~+t of th~ Sts» of Florida s~nu ' day of
. D~e~i~r
19_~. and 1 nside N m~~ ~~t
(SMeef end Number)
lORT ~IERCE, SAINT LUCIE COUNTY, RORIDA
and fhis statement is ro bs taken es my dsda~etion. of citizenship, actual leqai residence and domkile in ths Staro of Horida.
(I~uert hero any pertinent facis, wch u sale of preperty or businass, or relinquishnwnt of employm~nt
at f~msr domicil~, ra~raval of family b new domicile, purchsse of twme, ~tc.) .
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I RJRTHER CERTIFY that 1 will oomply with ~11 ottkr r~quire~rwnri of a lpai retident of this State.
1 FURTHER CERTIFY that i have no intention to retum to my former rlomicile, and 1 intend to remain in FOitY
PIERCE, S~AIN7 LUCIE COUNTY, FLORI~A, p~tman~nNy. -
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~~'Sv+ior+~~oti' and wbsuibsd befon n~ this day of 19 .
ROGER ~OtTRAS .
Ci~K C{RCWT COURT Natary Pvblic
By ~'`"~`"e ~ D.C. My Commission axpiros
Q~ w ac~~+YNd M drpNeat~ aMl eeiyi~al fil~ wilh Cl~k Cinaiif Cer~f, awd dvplieat~ whh T~x Ais~s~ora .
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