HomeMy WebLinkAbout2825 O~ala~ation of Do~lall~ ae~d CitisMShl~ 2l )~~t~Z
TO THE STAiE ANO COUNTY TAX ASSESSOR, .
Sl. IIKIE COUNTY, FIORIDA:
Thi: i: my declsration of ~omicile and Citi~ship in th~ St~t~ of Florida th~t I am filin~ thi: day in aooordano~ and
in conformity with Ctt~pte? 222, Ssctioo 2?2.17, florida Statut~s.
1 was forme~ly a legal resident of ~ •
~ / S (City~~ (Stah)
~ ~ n n _
and 1 ~esided at ` - „r However 1 have chanQed my domidle
(St~eet and Number)
to a~d am and have been a bona fide resident of the State of Florida sinoe ~ ~ 4 6 9 day of
- . 19 , and I reside as ~g ~ 3 ~ -tX]~+~~'+ _
tre and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORI~A
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here any pertinent facts, such as sa(e of property o~ business, or relinquishment of empioyment
at former domicile, removal of family to ~ew domitile, purthase of home, etc.) _
2C 4092
p~EO ~NO aECORpp ~
tT.IR
CERC
OITA~I~S~
~ CIEIIK Ci~CUIT OOWIt
RECOR~ ~tER~F1E0
fEe Z 10 ~a ~M'TI -
k
~
!
~
~
''s
~ I FURTHER CERTIFY that I will aomply with all other requirements of a le~al resident of thts State.
I FURTHER CERTIFY that I have no intention~ b retum to my former domiyle, and 1 intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. (~lY/~ ~y,vc FQrL4n e
~
~ l!/lfS1L > > 71I.Q~L~dV1X.~n,~
~ ~ (Name) .
~
~
- ~
~ _
(Address)
~ ~
~ /L~ .
~ ~ Sworn to..~hd svbscribed before me this day of , 19~.
`,,~~NII:Ii:y~
f~~' -
~ ti~~~~ 4S ~ > ' ~~~f
i
~ ~
• ~ i
~ `
~ _ r ~R ~ Notary Public
~ "
~ gY " _ D.C. My ~ommission expires
. . <.,;,t ~ ~ ` Ci
~ - • ~ , J ~
~ i•' i.;~ l,~.a~;~. f••
~ _ :
~ ;~11 ~t~1~ atld Of~IN~ W~I~I ~ ~Oll~f ~iOYff~ ~Ild d11~~C~N Wj1~1 T~ AlNMOf.~
~ ~~~~ll:..~t'~t'~1` •
~ Bo~x~89 281~ ~
: _ ~
~ ~ t
~
=~~~.~A ~~.t , : ~~-~=;~5