HomeMy WebLinkAbout2897 ~ ~
O~lu~tlo~ of 0o~1a11~ a~ Citis~nslaip ~
;
10 TI# S~ATE AND COUNTY TAX ASSESSOR;
2041~~~ ~
sl. ttK1E COUNTY, FlOR1oA~ . ;
thit is my d~cl~r~tion of Domicil~ a~d Citi~nship in th~ 8tat~ of Flaida that 1~m fiiinp thi~ d~y i~ ~ooordano~ a~d
~n cor~formity with ChaptN 72Z. S~ction 232.17, Norid~ St~tuhs.
1 w~: form~tly ~ Ip~l r~sid~nt of ~ /-~0.
t~~h) (Stah)
and 1 ~esidsd st Li(/~Q ~ Hovwver I hav~ chan~sd my domkile
(Sh~et and Number)
to and am a~d have been a bona fide msidant of the Stah of Florida sinos ~~=~~6•G+~- dey of .
z- 0 ~ ~
--v~~- . 19~, and ! reside at
~ (Street a~d Nu )
fORT lI~tCE, SAINT LtiC1E COUNTY, ROR~A
ar?d this statement is to be taken as my declaration of ati=enship, attual legal residence and domicile in the Staro of Horida.
(Insert here any peniM ~t facts, such as sale of property or bu:ineu, or relinquishment of employment '
st fomner domicile, romoval of family ro new domicile, purchase of horne, etc.)
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f1~E0 AKQ REC,Q_R~~
/~~"'~E~ ~'S.~- sL ROCER
POt~S
~ ~ ~ ~ RECORO YERIFIEO ~t
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fEe i~ AM'11
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2~4140 -
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~ I FURTHER CERTIFY that 1 will comply witfi all other requiremsnn of a le~al rsside~t of this State.
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~ 1 FURTHER CERTIFY that I have no intention to retum to my former domicjle, and I intend to remain in FORT
' PIERCE, SAINT IUCIE COUNTY, FLORIDA, permanently.
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C~!~ E S S S T~~ /?,e NS
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. ' SMibe~S ~oaaand wbscribed before me this day of ~ ~ 9
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'''s.:;;;tf,,~ ~T Nahry Public
By . D.C. My Commitsion expir~s
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R~ M anc~Ni M dYpiicM~ aur oei~b~ai tiiMl wilh Cl~elc CkerN Cow~, ~ad d~lis~N wilb Tax A~~.)
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