HomeMy WebLinkAbout2995 ~ia~atlo~ ot Oorniaii~ a~d CKis~nshlp
TO THE STAtE AND COUNTY TAX ASSESSOR, 2~~~2U2
Si . lUC1E COUNTY, FLORIUA
This ~s my declarat~o~ of ~om~ule snd Cit~z~n=h~p in the State of Florid• th~t I~m fil~~y thii dsy in ~ccp?danc~ ~nd
~n confo~mity w~th Chapter ?22, Sectio~ 222.17, Floride Statut~t.
_i --y~
1 was formerly s leqal resident of \~{dMZ1- - - - _ _ 1!__ -
(City) (State)
and 1 ~esided at - ~ - I~G~ . Nowever I have chanqed my domiGle
(Street and Number)
to and am and have been a bona fide resident of the Sfate of Florida since ~ i- day of
- - - 19~~_, and I ~eside at ~11.~~C~,t,~ L/.r.cQ. -
(Street and Numbe~)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence a~d domiciie in the State of Florida.
(Insert here any pertinent fads, 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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IIOCER POITRA!
CIERR CI~CUIt COUAT
IIECORO vEaiF~Ep..~..._
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~ 1 FURTHER CERTIFY that I will comply with all other requirements of a leyal resident of this State.
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~ I fURTHER CERTIFY that I have no intention to return to my fo~mer domicjle, and i intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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`"NUHa~uri~;~
~~~~;~~i e~? ~ ' ~ (Name)
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~ ~~=1, . ,tO;aiW-wburibed before me this day of , 197r .
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Roc~ roiTrt~s _ :
~ CIRCUIT C URT Notary Public i
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By D.C. My Commission expires ~
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~ (To b~ ~x~cut~d in d~?pliut~ snd ori~inal fil~d witl~ Cl~k Gnuk Court, and duplica» with Tax Ass~or.)
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