HomeMy WebLinkAbout2926 Oaclaration of Domi~lie and Citlsenship
TO THE STATE AND COUNTY TAX ASSESSOR, 4
~~h~ ~ E
Sl. IUCIE COUNTY, FIORI~A:
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This is my decla~ation of Oomicile and Citizenship in the State of Flo~ida thst 1 am filing this day in ecoo~danos and
in eonformity with Chapter 222, Sectio~ 222.17, Florida Statutss.
1 was formerly a legal resident of _$l~8._~Z _ Naw Yor]c
(Ciry) tStaro)
and 1 resided at ----~-$BIIepL.l~a.~_- However 1 have changed my domic,ile
. (St~eet and Number)
ro and am a~d have been a bona fide ~esident of the State of Florida sinoe 3 ~
at _ day of
,_1~8?.Y_ ,~9 , and I reside at 140 1I.8. 8o11da Dr. ~ POrt 3t. I+lic1•
(Street and Number)
FORT ~IERCE, SAINT LUCIE COUNTY, RORI~A
and this stateme~t is to be taker~ as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here any pertinent fads, such as sale of property or business, or refinquishment of employment
at former domicile, removal of family to new domicile, .purchase of home, etc.)
RBSIDBNCB ~
FuEO ANa sECO
~{?c~E cou ~r
~~3ER PO?~ ~ ~
~l ttK C~l~C, IT
RfC0R0 YER+f~~p ~ ~
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. 210~4
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~ 1 FURTHER CHtTIFY that I will oomply wifh all other requiromenb of a la~al resident of this State.
~ I FURTHER CERTIFY that I have no intention to retum to my former domitile, a~d 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, pe~manently. ~
'
B JAl[IA H. CROSBY
~ (Name) ~
~ `v IT,~ C. :i,,'.. _ • F
~ ',~~~~.~~~u~nth~~~'/ ,~f . ;
Y
~~y.~'-~N-~•.~ 7 40 1~. E. 3olida Dr. Port 3t . Lwc is
~ :_ir~ -
~ ~ r ~ ' ' (Address)
E ` h~ ~ ' 33450
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~ ~s~ ~~ed.'~efore me this 8th day of dUAe , 19~.
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~ : y'y~ ~ tv~•r~`~.• -
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, j Notary Public
By ' D.C. My Commission expires
(Te b~ ~x~eu/~d iN dvpliut~ and ori~inal fil~d w~th CENk Cireuit Cour~, and duplieat~ with Tax A~or.)
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